| National Provider Identifier [NPI]: | 1114185907 |
| Last Name Of The Provider | WYSE |
| First Name Of The Provider | SHELLEY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | P.A.-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 388 DAMASCUS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARYSVILLE |
| Zip Code Of The Provider | 430405535 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 441 |
| Number Of Medicare Beneficiaries | 138 |
| Total Submitted Charge Amount | 37035.5 |
| Total Medicare Allowed Amount | 23803.87 |
| Total Medicare Payment Amount | 17274.42 |
| Total Medicare Standardized Payment Amount | 21427.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 59 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1270.5 |
| Total Drug Medicare AllowedAmount | 710.92 |
| Total Drug Medicare PaymentAmount | 671.51 |
| Total Drug Medicare Standardized Payment Amount | 671.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 382 |
| Number Of Medicare Beneficiaries With Medical Services | 138 |
| Total Medical Submitted Charge Amount | 35765 |
| Total Medical Medicare Allowed Amount | 23092.95 |
| Total Medical Medicare Payment Amount | 16602.91 |
| Total Medical Medicare Standardized Payment Amount | 20756.06 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 96 |
| Number Of Male Beneficiaries | 42 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 105 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| 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 | 20 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0415 |