| National Provider Identifier [NPI]: | 1497865711 |
| Last Name Of The Provider | WYNN |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11766 HIGHWAY 27 |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | SUMMERVILLE |
| Zip Code Of The Provider | 307475989 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 3411 |
| Number Of Medicare Beneficiaries | 414 |
| Total Submitted Charge Amount | 165361 |
| Total Medicare Allowed Amount | 90355.95 |
| Total Medicare Payment Amount | 62036.07 |
| Total Medicare Standardized Payment Amount | 79927.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 1760 |
| Number Of Medicare Beneficiaries With Drug Services | 206 |
| Total Drug Submitted ChargeAmount | 27924 |
| Total Drug Medicare AllowedAmount | 4859.43 |
| Total Drug Medicare PaymentAmount | 4533.73 |
| Total Drug Medicare Standardized Payment Amount | 4533.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 1651 |
| Number Of Medicare Beneficiaries With Medical Services | 414 |
| Total Medical Submitted Charge Amount | 137437 |
| Total Medical Medicare Allowed Amount | 85496.52 |
| Total Medical Medicare Payment Amount | 57502.34 |
| Total Medical Medicare Standardized Payment Amount | 75393.4 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 132 |
| Number Of Beneficiaries Age 65 to 74 | 174 |
| Number Of Beneficiaries Age 75 to 84 | 78 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 244 |
| Number Of Male Beneficiaries | 170 |
| Number Of Non Hispanic White Beneficiaries | 379 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 225 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 189 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.305 |