| National Provider Identifier [NPI]: | 1164472577 |
| Last Name Of The Provider | WIESKOPF |
| First Name Of The Provider | BRAM |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1192 BUCKHEAD XING |
| Street Address 2 Of The Provider | SUITE E |
| City Of The Provider | WOODSTOCK |
| Zip Code Of The Provider | 301894254 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 22507 |
| Number Of Medicare Beneficiaries | 869 |
| Total Submitted Charge Amount | 1360395 |
| Total Medicare Allowed Amount | 577389.26 |
| Total Medicare Payment Amount | 443153.4 |
| Total Medicare Standardized Payment Amount | 444173.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 18 |
| Number Of Drug Services | 18310 |
| Number Of Medicare Beneficiaries With Drug Services | 442 |
| Total Drug Submitted ChargeAmount | 739977 |
| Total Drug Medicare AllowedAmount | 298224.13 |
| Total Drug Medicare PaymentAmount | 232634.7 |
| Total Drug Medicare Standardized Payment Amount | 232634.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 4197 |
| Number Of Medicare Beneficiaries With Medical Services | 869 |
| Total Medical Submitted Charge Amount | 620418 |
| Total Medical Medicare Allowed Amount | 279165.13 |
| Total Medical Medicare Payment Amount | 210518.7 |
| Total Medical Medicare Standardized Payment Amount | 211539.27 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 416 |
| Number Of Beneficiaries Age 75 to 84 | 318 |
| Number Of Beneficiaries Age Greater 84 | 97 |
| Number Of Female Beneficiaries | 672 |
| Number Of Male Beneficiaries | 197 |
| Number Of Non Hispanic White Beneficiaries | 807 |
| Number Of Black or African American Beneficiaries | 19 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 838 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 60 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0374 |