| National Provider Identifier [NPI]: | 1184634586 |
| Last Name Of The Provider | WISE |
| First Name Of The Provider | DENISE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 5TH AVE |
| Street Address 2 Of The Provider | SUITE 400 |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761047300 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 86 |
| Number Of Services | 4624 |
| Number Of Medicare Beneficiaries | 2011 |
| Total Submitted Charge Amount | 874523 |
| Total Medicare Allowed Amount | 351234.78 |
| Total Medicare Payment Amount | 312334.01 |
| Total Medicare Standardized Payment Amount | 245647.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1116 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 1556 |
| Total Drug Medicare AllowedAmount | 389.19 |
| Total Drug Medicare PaymentAmount | 293.83 |
| Total Drug Medicare Standardized Payment Amount | 293.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 84 |
| Number Of Medical Services | 3508 |
| Number Of Medicare Beneficiaries With Medical Services | 2011 |
| Total Medical Submitted Charge Amount | 872967 |
| Total Medical Medicare Allowed Amount | 350845.59 |
| Total Medical Medicare Payment Amount | 312040.18 |
| Total Medical Medicare Standardized Payment Amount | 245353.58 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 165 |
| Number Of Beneficiaries Age 65 to 74 | 1095 |
| Number Of Beneficiaries Age 75 to 84 | 602 |
| Number Of Beneficiaries Age Greater 84 | 149 |
| Number Of Female Beneficiaries | 1737 |
| Number Of Male Beneficiaries | 274 |
| Number Of Non Hispanic White Beneficiaries | 912 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 806 |
| Number Of Hispanic Beneficiaries | 190 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 77 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1230 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 781 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9187 |