| National Provider Identifier [NPI]: | 1770589350 |
| Last Name Of The Provider | NICHOLS |
| First Name Of The Provider | DALE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1112 E WEISGARBER RD |
| Street Address 2 Of The Provider | STE 201 |
| City Of The Provider | KNOXVILLE |
| Zip Code Of The Provider | 379092647 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 156 |
| Number Of Services | 6373 |
| Number Of Medicare Beneficiaries | 2625 |
| Total Submitted Charge Amount | 540759.79 |
| Total Medicare Allowed Amount | 169531.31 |
| Total Medicare Payment Amount | 133158.42 |
| Total Medicare Standardized Payment Amount | 144867.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 2657 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 3351 |
| Total Drug Medicare AllowedAmount | 964.47 |
| Total Drug Medicare PaymentAmount | 728.7 |
| Total Drug Medicare Standardized Payment Amount | 728.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 152 |
| Number Of Medical Services | 3716 |
| Number Of Medicare Beneficiaries With Medical Services | 2624 |
| Total Medical Submitted Charge Amount | 537408.79 |
| Total Medical Medicare Allowed Amount | 168566.84 |
| Total Medical Medicare Payment Amount | 132429.72 |
| Total Medical Medicare Standardized Payment Amount | 144138.7 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 519 |
| Number Of Beneficiaries Age 65 to 74 | 1026 |
| Number Of Beneficiaries Age 75 to 84 | 743 |
| Number Of Beneficiaries Age Greater 84 | 337 |
| Number Of Female Beneficiaries | 1573 |
| Number Of Male Beneficiaries | 1052 |
| Number Of Non Hispanic White Beneficiaries | 2490 |
| Number Of Black or African American Beneficiaries | 97 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1887 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 738 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5533 |