| National Provider Identifier [NPI]: | 1790989317 |
| Last Name Of The Provider | GEORGE |
| First Name Of The Provider | WISAM |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 40905 W 10 MILE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | NOVI |
| Zip Code Of The Provider | 483753507 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 2357 |
| Number Of Medicare Beneficiaries | 452 |
| Total Submitted Charge Amount | 812143 |
| Total Medicare Allowed Amount | 129081.01 |
| Total Medicare Payment Amount | 98505.45 |
| Total Medicare Standardized Payment Amount | 94322.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 1329 |
| Number Of Medicare Beneficiaries With Drug Services | 100 |
| Total Drug Submitted ChargeAmount | 71655 |
| Total Drug Medicare AllowedAmount | 1608.4 |
| Total Drug Medicare PaymentAmount | 1260.62 |
| Total Drug Medicare Standardized Payment Amount | 1260.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 94 |
| Number Of Medical Services | 1028 |
| Number Of Medicare Beneficiaries With Medical Services | 452 |
| Total Medical Submitted Charge Amount | 740488 |
| Total Medical Medicare Allowed Amount | 127472.61 |
| Total Medical Medicare Payment Amount | 97244.83 |
| Total Medical Medicare Standardized Payment Amount | 93061.61 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 202 |
| Number Of Beneficiaries Age 75 to 84 | 135 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 277 |
| Number Of Male Beneficiaries | 175 |
| Number Of Non Hispanic White Beneficiaries | 416 |
| Number Of Black or African American Beneficiaries | 20 |
| 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 | 400 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3109 |