| National Provider Identifier [NPI]: | 1497792402 |
| Last Name Of The Provider | WICKS |
| First Name Of The Provider | ALLAN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1230 E 1ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CASPER |
| Zip Code Of The Provider | 826012704 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 6875 |
| Number Of Medicare Beneficiaries | 1728 |
| Total Submitted Charge Amount | 2142045 |
| Total Medicare Allowed Amount | 359169.39 |
| Total Medicare Payment Amount | 265440.08 |
| Total Medicare Standardized Payment Amount | 265600.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 2455 |
| Number Of Medicare Beneficiaries With Drug Services | 108 |
| Total Drug Submitted ChargeAmount | 56893 |
| Total Drug Medicare AllowedAmount | 19115.94 |
| Total Drug Medicare PaymentAmount | 14590.16 |
| Total Drug Medicare Standardized Payment Amount | 14590.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 4420 |
| Number Of Medicare Beneficiaries With Medical Services | 1728 |
| Total Medical Submitted Charge Amount | 2085152 |
| Total Medical Medicare Allowed Amount | 340053.45 |
| Total Medical Medicare Payment Amount | 250849.92 |
| Total Medical Medicare Standardized Payment Amount | 251010.79 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 166 |
| Number Of Beneficiaries Age 65 to 74 | 653 |
| Number Of Beneficiaries Age 75 to 84 | 631 |
| Number Of Beneficiaries Age Greater 84 | 278 |
| Number Of Female Beneficiaries | 881 |
| Number Of Male Beneficiaries | 847 |
| Number Of Non Hispanic White Beneficiaries | 1607 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 52 |
| Number Of American Indian Alaska Native Beneficiaries | 31 |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1467 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 261 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3252 |