| National Provider Identifier [NPI]: | 1881883338 |
| Last Name Of The Provider | WIKE |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | OD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4600 GREENVILLE AVE |
| Street Address 2 Of The Provider | #292 |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752065062 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 4720 |
| Number Of Medicare Beneficiaries | 2326 |
| Total Submitted Charge Amount | 514910 |
| Total Medicare Allowed Amount | 487538.23 |
| Total Medicare Payment Amount | 361785 |
| Total Medicare Standardized Payment Amount | 367981.92 |
| 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 | 14 |
| Number Of Medical Services | 4720 |
| Number Of Medicare Beneficiaries With Medical Services | 2326 |
| Total Medical Submitted Charge Amount | 514910 |
| Total Medical Medicare Allowed Amount | 487538.23 |
| Total Medical Medicare Payment Amount | 361785 |
| Total Medical Medicare Standardized Payment Amount | 367981.92 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 401 |
| Number Of Beneficiaries Age 65 to 74 | 532 |
| Number Of Beneficiaries Age 75 to 84 | 630 |
| Number Of Beneficiaries Age Greater 84 | 763 |
| Number Of Female Beneficiaries | 1486 |
| Number Of Male Beneficiaries | 840 |
| Number Of Non Hispanic White Beneficiaries | 1540 |
| Number Of Black or African American Beneficiaries | 588 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 169 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 205 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2121 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 59 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 68 |
| Percent Of With Diabetes | 61 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 34 |
| Percent Of With Stroke | 21 |
| Average HCC Risk Score Of Beneficiaries | 2.7161 |