| National Provider Identifier [NPI]: | 1881616795 |
| Last Name Of The Provider | WISKOWSKI |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 675 TOWER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HARTFORD |
| Zip Code Of The Provider | 061121260 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 866 |
| Number Of Medicare Beneficiaries | 103 |
| Total Submitted Charge Amount | 77132 |
| Total Medicare Allowed Amount | 39818.78 |
| Total Medicare Payment Amount | 28368.48 |
| Total Medicare Standardized Payment Amount | 26826.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 48 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 1786 |
| Total Drug Medicare AllowedAmount | 743.11 |
| Total Drug Medicare PaymentAmount | 727.44 |
| Total Drug Medicare Standardized Payment Amount | 727.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 818 |
| Number Of Medicare Beneficiaries With Medical Services | 103 |
| Total Medical Submitted Charge Amount | 75346 |
| Total Medical Medicare Allowed Amount | 39075.67 |
| Total Medical Medicare Payment Amount | 27641.04 |
| Total Medical Medicare Standardized Payment Amount | 26099.04 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 35 |
| Number Of Beneficiaries Age 75 to 84 | 18 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 89 |
| Number Of Male Beneficiaries | 14 |
| Number Of Non Hispanic White Beneficiaries | 17 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 44 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 19 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3165 |