National Provider Identifier [NPI]: |
1346200060 |
Last Name Of The Provider |
WYSE |
First Name Of The Provider |
MARK |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4350 E CAMELBACK RD |
Street Address 2 Of The Provider |
SUITE F-100 |
City Of The Provider |
PHOENIX |
Zip Code Of The Provider |
850182701 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
89 |
Number Of Services |
6186 |
Number Of Medicare Beneficiaries |
534 |
Total Submitted Charge Amount |
634466.5 |
Total Medicare Allowed Amount |
314305.97 |
Total Medicare Payment Amount |
234249.03 |
Total Medicare Standardized Payment Amount |
240335.7 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
112 |
Number Of Medicare Beneficiaries With Drug Services |
95 |
Total Drug Submitted ChargeAmount |
2701 |
Total Drug Medicare AllowedAmount |
1382.89 |
Total Drug Medicare PaymentAmount |
1348.22 |
Total Drug Medicare Standardized Payment Amount |
1348.22 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
84 |
Number Of Medical Services |
6074 |
Number Of Medicare Beneficiaries With Medical Services |
534 |
Total Medical Submitted Charge Amount |
631765.5 |
Total Medical Medicare Allowed Amount |
312923.08 |
Total Medical Medicare Payment Amount |
232900.81 |
Total Medical Medicare Standardized Payment Amount |
238987.48 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
27 |
Number Of Beneficiaries Age 65 to 74 |
229 |
Number Of Beneficiaries Age 75 to 84 |
171 |
Number Of Beneficiaries Age Greater 84 |
107 |
Number Of Female Beneficiaries |
286 |
Number Of Male Beneficiaries |
248 |
Number Of Non Hispanic White Beneficiaries |
481 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
22 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
11 |
Number Of Beneficiaries With Medicare Only Entitlement |
511 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
23 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
12 |
Percent Of With Diabetes |
20 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
0.9809 |