| National Provider Identifier [NPI]: | 1770664732 |
| Last Name Of The Provider | WIESENTHAL |
| First Name Of The Provider | MARTIN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8038 WURZBACH RD |
| Street Address 2 Of The Provider | SUITE 320 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782293817 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 10479 |
| Number Of Medicare Beneficiaries | 1501 |
| Total Submitted Charge Amount | 947140 |
| Total Medicare Allowed Amount | 666030.77 |
| Total Medicare Payment Amount | 501651.65 |
| Total Medicare Standardized Payment Amount | 527491.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 633 |
| Number Of Medicare Beneficiaries With Drug Services | 495 |
| Total Drug Submitted ChargeAmount | 18354 |
| Total Drug Medicare AllowedAmount | 10163.9 |
| Total Drug Medicare PaymentAmount | 9723.98 |
| Total Drug Medicare Standardized Payment Amount | 9723.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 9846 |
| Number Of Medicare Beneficiaries With Medical Services | 1501 |
| Total Medical Submitted Charge Amount | 928786 |
| Total Medical Medicare Allowed Amount | 655866.87 |
| Total Medical Medicare Payment Amount | 491927.67 |
| Total Medical Medicare Standardized Payment Amount | 517767.9 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 169 |
| Number Of Beneficiaries Age 65 to 74 | 726 |
| Number Of Beneficiaries Age 75 to 84 | 435 |
| Number Of Beneficiaries Age Greater 84 | 171 |
| Number Of Female Beneficiaries | 845 |
| Number Of Male Beneficiaries | 656 |
| Number Of Non Hispanic White Beneficiaries | 1072 |
| Number Of Black or African American Beneficiaries | 69 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 319 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1363 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 138 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1144 |