| National Provider Identifier [NPI]: | 1114188497 |
| Last Name Of The Provider | WISEMAN |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2500 S. LAKELINE BLVD. |
| Street Address 2 Of The Provider | STE. 100 |
| City Of The Provider | CEDAR PARK |
| Zip Code Of The Provider | 78613 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 626 |
| Number Of Medicare Beneficiaries | 210 |
| Total Submitted Charge Amount | 30417.3 |
| Total Medicare Allowed Amount | 26087.24 |
| Total Medicare Payment Amount | 19036.28 |
| Total Medicare Standardized Payment Amount | 21404.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 129.67 |
| Total Drug Medicare AllowedAmount | 63.58 |
| Total Drug Medicare PaymentAmount | 54.33 |
| Total Drug Medicare Standardized Payment Amount | 54.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 602 |
| Number Of Medicare Beneficiaries With Medical Services | 210 |
| Total Medical Submitted Charge Amount | 30287.63 |
| Total Medical Medicare Allowed Amount | 26023.66 |
| Total Medical Medicare Payment Amount | 18981.95 |
| Total Medical Medicare Standardized Payment Amount | 21350.22 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 150 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 128 |
| Number Of Male Beneficiaries | 82 |
| Number Of Non Hispanic White Beneficiaries | 195 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7289 |