National Provider Identifier [NPI]: |
1083652374 |
Last Name Of The Provider |
WYNN |
First Name Of The Provider |
JAMES |
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 |
45 NE LOOP 410 |
Street Address 2 Of The Provider |
SUITE 410 |
City Of The Provider |
SAN ANTONIO |
Zip Code Of The Provider |
782165832 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
33 |
Number Of Services |
238 |
Number Of Medicare Beneficiaries |
212 |
Total Submitted Charge Amount |
495084 |
Total Medicare Allowed Amount |
89994.05 |
Total Medicare Payment Amount |
70147.31 |
Total Medicare Standardized Payment Amount |
72825.84 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
33 |
Number Of Medical Services |
238 |
Number Of Medicare Beneficiaries With Medical Services |
212 |
Total Medical Submitted Charge Amount |
495084 |
Total Medical Medicare Allowed Amount |
89994.05 |
Total Medical Medicare Payment Amount |
70147.31 |
Total Medical Medicare Standardized Payment Amount |
72825.84 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
104 |
Number Of Beneficiaries Age 75 to 84 |
73 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
107 |
Number Of Male Beneficiaries |
105 |
Number Of Non Hispanic White Beneficiaries |
153 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
44 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
199 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
13 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
17 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
30 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
45 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
71 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.0976 |