| National Provider Identifier [NPI]: | 1043205586 |
| Last Name Of The Provider | WISE |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1006 W MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOZEMAN |
| Zip Code Of The Provider | 597153219 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 1401 |
| Number Of Medicare Beneficiaries | 606 |
| Total Submitted Charge Amount | 79874.47 |
| Total Medicare Allowed Amount | 50614.56 |
| Total Medicare Payment Amount | 35795.97 |
| Total Medicare Standardized Payment Amount | 35846.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 289 |
| Number Of Medicare Beneficiaries With Drug Services | 214 |
| Total Drug Submitted ChargeAmount | 4126.38 |
| Total Drug Medicare AllowedAmount | 3225.7 |
| Total Drug Medicare PaymentAmount | 3077.26 |
| Total Drug Medicare Standardized Payment Amount | 3077.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 1112 |
| Number Of Medicare Beneficiaries With Medical Services | 606 |
| Total Medical Submitted Charge Amount | 75748.09 |
| Total Medical Medicare Allowed Amount | 47388.86 |
| Total Medical Medicare Payment Amount | 32718.71 |
| Total Medical Medicare Standardized Payment Amount | 32769.35 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 284 |
| Number Of Beneficiaries Age 75 to 84 | 189 |
| Number Of Beneficiaries Age Greater 84 | 111 |
| Number Of Female Beneficiaries | 317 |
| Number Of Male Beneficiaries | 289 |
| Number Of Non Hispanic White Beneficiaries | 591 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 4 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 10 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 32 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.7468 |