| National Provider Identifier [NPI]: | 1942342126 |
| Last Name Of The Provider | WISE |
| First Name Of The Provider | IRENE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | FNP RN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 710 N BEAVER ST |
| Street Address 2 Of The Provider | BUILDING 6 |
| City Of The Provider | FLAGSTAFF |
| Zip Code Of The Provider | 860013100 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 388 |
| Number Of Medicare Beneficiaries | 111 |
| Total Submitted Charge Amount | 44108.86 |
| Total Medicare Allowed Amount | 23515.04 |
| Total Medicare Payment Amount | 17104.04 |
| Total Medicare Standardized Payment Amount | 20318.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 945.64 |
| Total Drug Medicare AllowedAmount | 620.79 |
| Total Drug Medicare PaymentAmount | 602.54 |
| Total Drug Medicare Standardized Payment Amount | 602.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 354 |
| Number Of Medicare Beneficiaries With Medical Services | 111 |
| Total Medical Submitted Charge Amount | 43163.22 |
| Total Medical Medicare Allowed Amount | 22894.25 |
| Total Medical Medicare Payment Amount | 16501.5 |
| Total Medical Medicare Standardized Payment Amount | 19715.62 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 24 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 77 |
| Number Of Male Beneficiaries | 34 |
| Number Of Non Hispanic White Beneficiaries | 95 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 94 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1112 |