| National Provider Identifier [NPI]: | 1255383162 |
| Last Name Of The Provider | NIDHIRY |
| First Name Of The Provider | EMMANUEL |
| 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 | 169 JT PETTEY DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | RUSSELL SPRINGS |
| Zip Code Of The Provider | 42642 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 25393 |
| Number Of Medicare Beneficiaries | 675 |
| Total Submitted Charge Amount | 1941786.88 |
| Total Medicare Allowed Amount | 716271.04 |
| Total Medicare Payment Amount | 553526.08 |
| Total Medicare Standardized Payment Amount | 564657.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 47 |
| Number Of Drug Services | 20442 |
| Number Of Medicare Beneficiaries With Drug Services | 66 |
| Total Drug Submitted ChargeAmount | 696231.37 |
| Total Drug Medicare AllowedAmount | 255313.4 |
| Total Drug Medicare PaymentAmount | 198081.53 |
| Total Drug Medicare Standardized Payment Amount | 198081.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 4951 |
| Number Of Medicare Beneficiaries With Medical Services | 675 |
| Total Medical Submitted Charge Amount | 1245555.51 |
| Total Medical Medicare Allowed Amount | 460957.64 |
| Total Medical Medicare Payment Amount | 355444.55 |
| Total Medical Medicare Standardized Payment Amount | 366575.79 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 150 |
| Number Of Beneficiaries Age 65 to 74 | 268 |
| Number Of Beneficiaries Age 75 to 84 | 196 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 391 |
| Number Of Male Beneficiaries | 284 |
| Number Of Non Hispanic White Beneficiaries | 634 |
| Number Of Black or African American Beneficiaries | |
| 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 | 414 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 261 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 42 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.878 |