| National Provider Identifier [NPI]: | 1184622573 |
| Last Name Of The Provider | WICKWIRE |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1203 E FERGUSON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHARR |
| Zip Code Of The Provider | 785772706 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 173 |
| Number Of Services | 9235 |
| Number Of Medicare Beneficiaries | 936 |
| Total Submitted Charge Amount | 387932 |
| Total Medicare Allowed Amount | 107949.95 |
| Total Medicare Payment Amount | 100186.82 |
| Total Medicare Standardized Payment Amount | 101205.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 353 |
| Number Of Medicare Beneficiaries With Drug Services | 253 |
| Total Drug Submitted ChargeAmount | 11307 |
| Total Drug Medicare AllowedAmount | 7885.94 |
| Total Drug Medicare PaymentAmount | 7639.9 |
| Total Drug Medicare Standardized Payment Amount | 7639.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 160 |
| Number Of Medical Services | 8882 |
| Number Of Medicare Beneficiaries With Medical Services | 934 |
| Total Medical Submitted Charge Amount | 376625 |
| Total Medical Medicare Allowed Amount | 100064.01 |
| Total Medical Medicare Payment Amount | 92546.92 |
| Total Medical Medicare Standardized Payment Amount | 93565.43 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 335 |
| Number Of Beneficiaries Age 65 to 74 | 486 |
| Number Of Beneficiaries Age 75 to 84 | 94 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 502 |
| Number Of Male Beneficiaries | 434 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 902 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 366 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 570 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 62 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0981 |