National Provider Identifier [NPI]: |
1255336947 |
Last Name Of The Provider |
WILKE |
First Name Of The Provider |
GISELE |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6839 S CANTON AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
TULSA |
Zip Code Of The Provider |
741363402 |
State Code Of The Provider |
OK |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
65 |
Number Of Services |
324 |
Number Of Medicare Beneficiaries |
218 |
Total Submitted Charge Amount |
178005 |
Total Medicare Allowed Amount |
34200.27 |
Total Medicare Payment Amount |
26280.34 |
Total Medicare Standardized Payment Amount |
27594.2 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
65 |
Number Of Medical Services |
324 |
Number Of Medicare Beneficiaries With Medical Services |
218 |
Total Medical Submitted Charge Amount |
178005 |
Total Medical Medicare Allowed Amount |
34200.27 |
Total Medical Medicare Payment Amount |
26280.34 |
Total Medical Medicare Standardized Payment Amount |
27594.2 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
37 |
Number Of Beneficiaries Age 65 to 74 |
87 |
Number Of Beneficiaries Age 75 to 84 |
70 |
Number Of Beneficiaries Age Greater 84 |
24 |
Number Of Female Beneficiaries |
118 |
Number Of Male Beneficiaries |
100 |
Number Of Non Hispanic White Beneficiaries |
186 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
17 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
184 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
34 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
28 |
Percent Of With Chronic Kidney Disease |
39 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
36 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
63 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.6519 |