| National Provider Identifier [NPI]: | 1093976045 |
| Last Name Of The Provider | WIEKING |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 537 UNION AVE |
| Street Address 2 Of The Provider | SECOND FLOOR, 2A |
| City Of The Provider | GRANTS PASS |
| Zip Code Of The Provider | 975275543 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 97 |
| Number Of Services | 670 |
| Number Of Medicare Beneficiaries | 135 |
| Total Submitted Charge Amount | 179692.88 |
| Total Medicare Allowed Amount | 65147.38 |
| Total Medicare Payment Amount | 50322.86 |
| Total Medicare Standardized Payment Amount | 52477.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 98 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 420 |
| Total Drug Medicare AllowedAmount | 181.71 |
| Total Drug Medicare PaymentAmount | 136.99 |
| Total Drug Medicare Standardized Payment Amount | 136.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 95 |
| Number Of Medical Services | 572 |
| Number Of Medicare Beneficiaries With Medical Services | 135 |
| Total Medical Submitted Charge Amount | 179272.88 |
| Total Medical Medicare Allowed Amount | 64965.67 |
| Total Medical Medicare Payment Amount | 50185.87 |
| Total Medical Medicare Standardized Payment Amount | 52340.95 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 62 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 90 |
| Number Of Male Beneficiaries | 45 |
| Number Of Non Hispanic White Beneficiaries | 124 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 107 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0135 |