National Provider Identifier [NPI]: |
1861500589 |
Last Name Of The Provider |
WILCOX |
First Name Of The Provider |
REX |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
MD PA |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
12709 TOEPPERWEIN RD |
Street Address 2 Of The Provider |
STE 101 |
City Of The Provider |
LIVE OAK |
Zip Code Of The Provider |
782333259 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Orthopedic Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
711 |
Number Of Medicare Beneficiaries |
161 |
Total Submitted Charge Amount |
122708.06 |
Total Medicare Allowed Amount |
40281.06 |
Total Medicare Payment Amount |
28721.18 |
Total Medicare Standardized Payment Amount |
30780.12 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
119 |
Number Of Medicare Beneficiaries With Drug Services |
46 |
Total Drug Submitted ChargeAmount |
9598 |
Total Drug Medicare AllowedAmount |
3120.87 |
Total Drug Medicare PaymentAmount |
2445.67 |
Total Drug Medicare Standardized Payment Amount |
2445.67 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
31 |
Number Of Medical Services |
592 |
Number Of Medicare Beneficiaries With Medical Services |
161 |
Total Medical Submitted Charge Amount |
113110.06 |
Total Medical Medicare Allowed Amount |
37160.19 |
Total Medical Medicare Payment Amount |
26275.51 |
Total Medical Medicare Standardized Payment Amount |
28334.45 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
90 |
Number Of Beneficiaries Age 75 to 84 |
46 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
96 |
Number Of Male Beneficiaries |
65 |
Number Of Non Hispanic White Beneficiaries |
118 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
23 |
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 |
8 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
68 |
Percent Of With Ischemic Heart Disease |
36 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
58 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8838 |