| National Provider Identifier [NPI]: | 1285611459 |
| Last Name Of The Provider | NICHOLS |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 1ST ST SW |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROCHESTER |
| Zip Code Of The Provider | 559050001 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 34958 |
| Number Of Medicare Beneficiaries | 1735 |
| Total Submitted Charge Amount | 286913.94 |
| Total Medicare Allowed Amount | 176464.98 |
| Total Medicare Payment Amount | 131437.05 |
| Total Medicare Standardized Payment Amount | 148861.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 32469 |
| Number Of Medicare Beneficiaries With Drug Services | 234 |
| Total Drug Submitted ChargeAmount | 7439.69 |
| Total Drug Medicare AllowedAmount | 5974.25 |
| Total Drug Medicare PaymentAmount | 4161.89 |
| Total Drug Medicare Standardized Payment Amount | 4161.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 91 |
| Number Of Medical Services | 2489 |
| Number Of Medicare Beneficiaries With Medical Services | 1734 |
| Total Medical Submitted Charge Amount | 279474.25 |
| Total Medical Medicare Allowed Amount | 170490.73 |
| Total Medical Medicare Payment Amount | 127275.16 |
| Total Medical Medicare Standardized Payment Amount | 144699.14 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 318 |
| Number Of Beneficiaries Age 65 to 74 | 662 |
| Number Of Beneficiaries Age 75 to 84 | 526 |
| Number Of Beneficiaries Age Greater 84 | 229 |
| Number Of Female Beneficiaries | 824 |
| Number Of Male Beneficiaries | 911 |
| Number Of Non Hispanic White Beneficiaries | 1645 |
| Number Of Black or African American Beneficiaries | 28 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1437 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 298 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.8358 |