| National Provider Identifier [NPI]: | 1548231269 |
| Last Name Of The Provider | WISNIEWSKI |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 518 WEST DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | OKOLONA |
| Zip Code Of The Provider | 388601624 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 429 |
| Number Of Medicare Beneficiaries | 71 |
| Total Submitted Charge Amount | 61734.2 |
| Total Medicare Allowed Amount | 37925.89 |
| Total Medicare Payment Amount | 24712.43 |
| Total Medicare Standardized Payment Amount | 27032.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 41 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 530 |
| Total Drug Medicare AllowedAmount | 193.27 |
| Total Drug Medicare PaymentAmount | 184.69 |
| Total Drug Medicare Standardized Payment Amount | 184.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 8 |
| Number Of Medical Services | 388 |
| Number Of Medicare Beneficiaries With Medical Services | 71 |
| Total Medical Submitted Charge Amount | 61204.2 |
| Total Medical Medicare Allowed Amount | 37732.62 |
| Total Medical Medicare Payment Amount | 24527.74 |
| Total Medical Medicare Standardized Payment Amount | 26847.48 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 32 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | 45 |
| 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 | 23 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8431 |