| National Provider Identifier [NPI]: | 1770525198 |
| Last Name Of The Provider | WIESCHHAUS |
| First Name Of The Provider | MARTIN |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 611 E DOUGLAS RD |
| Street Address 2 Of The Provider | STE 407 |
| City Of The Provider | MISHAWAKA |
| Zip Code Of The Provider | 465451464 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 467 |
| Number Of Medicare Beneficiaries | 155 |
| Total Submitted Charge Amount | 50604 |
| Total Medicare Allowed Amount | 30297.8 |
| Total Medicare Payment Amount | 21566.03 |
| Total Medicare Standardized Payment Amount | 23385.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 942 |
| Total Drug Medicare AllowedAmount | 596.16 |
| Total Drug Medicare PaymentAmount | 581.31 |
| Total Drug Medicare Standardized Payment Amount | 581.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 431 |
| Number Of Medicare Beneficiaries With Medical Services | 155 |
| Total Medical Submitted Charge Amount | 49662 |
| Total Medical Medicare Allowed Amount | 29701.64 |
| Total Medical Medicare Payment Amount | 20984.72 |
| Total Medical Medicare Standardized Payment Amount | 22804.5 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 99 |
| Number Of Male Beneficiaries | 56 |
| Number Of Non Hispanic White Beneficiaries | 129 |
| Number Of Black or African American Beneficiaries | |
| 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 | 93 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.9493 |