| National Provider Identifier [NPI]: | 1417065848 |
| Last Name Of The Provider | WICKLUND |
| First Name Of The Provider | ROGER |
| 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 | 9135 SW BARNES RD |
| Street Address 2 Of The Provider | STE. 663 |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 972256646 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 1694 |
| Number Of Medicare Beneficiaries | 250 |
| Total Submitted Charge Amount | 326291 |
| Total Medicare Allowed Amount | 119739.63 |
| Total Medicare Payment Amount | 89320.32 |
| Total Medicare Standardized Payment Amount | 89330.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 394 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 33892 |
| Total Drug Medicare AllowedAmount | 24237.85 |
| Total Drug Medicare PaymentAmount | 18936.14 |
| Total Drug Medicare Standardized Payment Amount | 18936.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 1300 |
| Number Of Medicare Beneficiaries With Medical Services | 250 |
| Total Medical Submitted Charge Amount | 292399 |
| Total Medical Medicare Allowed Amount | 95501.78 |
| Total Medical Medicare Payment Amount | 70384.18 |
| Total Medical Medicare Standardized Payment Amount | 70394.73 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 108 |
| Number Of Beneficiaries Age 75 to 84 | 77 |
| Number Of Beneficiaries Age Greater 84 | 45 |
| Number Of Female Beneficiaries | 42 |
| Number Of Male Beneficiaries | 208 |
| Number Of Non Hispanic White Beneficiaries | 220 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| 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 | 210 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 24 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2451 |