| National Provider Identifier [NPI]: | 1740467794 |
| Last Name Of The Provider | WISE |
| First Name Of The Provider | LAUREN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 305 PAUL BRYANT DRIVE E |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUSCALOOSA |
| Zip Code Of The Provider | 354032055 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 215 |
| Number Of Medicare Beneficiaries | 169 |
| Total Submitted Charge Amount | 238812 |
| Total Medicare Allowed Amount | 26197.68 |
| Total Medicare Payment Amount | 19449.16 |
| Total Medicare Standardized Payment Amount | 22176.64 |
| 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 | 64 |
| Number Of Medical Services | 215 |
| Number Of Medicare Beneficiaries With Medical Services | 169 |
| Total Medical Submitted Charge Amount | 238812 |
| Total Medical Medicare Allowed Amount | 26197.68 |
| Total Medical Medicare Payment Amount | 19449.16 |
| Total Medical Medicare Standardized Payment Amount | 22176.64 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 121 |
| Number Of Male Beneficiaries | 48 |
| Number Of Non Hispanic White Beneficiaries | 130 |
| Number Of Black or African American Beneficiaries | 39 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 127 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.23 |