| National Provider Identifier [NPI]: | 1003860313 |
| Last Name Of The Provider | WICKENS |
| First Name Of The Provider | JASON |
| 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 | 653 N TOWN CENTER DRIVE |
| Street Address 2 Of The Provider | SUITE 518 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 89144 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 11301 |
| Number Of Medicare Beneficiaries | 1040 |
| Total Submitted Charge Amount | 2853006.23 |
| Total Medicare Allowed Amount | 1750521.75 |
| Total Medicare Payment Amount | 1342589.95 |
| Total Medicare Standardized Payment Amount | 1335039.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 1841 |
| Number Of Medicare Beneficiaries With Drug Services | 189 |
| Total Drug Submitted ChargeAmount | 1466574 |
| Total Drug Medicare AllowedAmount | 787536.63 |
| Total Drug Medicare PaymentAmount | 612660.26 |
| Total Drug Medicare Standardized Payment Amount | 612660.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 9460 |
| Number Of Medicare Beneficiaries With Medical Services | 1040 |
| Total Medical Submitted Charge Amount | 1386432.23 |
| Total Medical Medicare Allowed Amount | 962985.12 |
| Total Medical Medicare Payment Amount | 729929.69 |
| Total Medical Medicare Standardized Payment Amount | 722379.62 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | 421 |
| Number Of Beneficiaries Age 75 to 84 | 354 |
| Number Of Beneficiaries Age Greater 84 | 200 |
| Number Of Female Beneficiaries | 574 |
| Number Of Male Beneficiaries | 466 |
| Number Of Non Hispanic White Beneficiaries | 862 |
| Number Of Black or African American Beneficiaries | 43 |
| Number Of AsianPacific Islander Beneficiaries | 41 |
| Number Of Hispanic Beneficiaries | 70 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 936 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 104 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3539 |