| National Provider Identifier [NPI]: | 1043254469 |
| Last Name Of The Provider | MITCHNICK |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5400 NESCONSET HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT JEFFERSON STATION |
| Zip Code Of The Provider | 117762028 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 12310 |
| Number Of Medicare Beneficiaries | 1300 |
| Total Submitted Charge Amount | 2386523.53 |
| Total Medicare Allowed Amount | 788910.83 |
| Total Medicare Payment Amount | 596757.42 |
| Total Medicare Standardized Payment Amount | 551136.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 5465 |
| Number Of Medicare Beneficiaries With Drug Services | 154 |
| Total Drug Submitted ChargeAmount | 755338.57 |
| Total Drug Medicare AllowedAmount | 271285.08 |
| Total Drug Medicare PaymentAmount | 210993.14 |
| Total Drug Medicare Standardized Payment Amount | 210993.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 73 |
| Number Of Medical Services | 6845 |
| Number Of Medicare Beneficiaries With Medical Services | 1300 |
| Total Medical Submitted Charge Amount | 1631184.96 |
| Total Medical Medicare Allowed Amount | 517625.75 |
| Total Medical Medicare Payment Amount | 385764.28 |
| Total Medical Medicare Standardized Payment Amount | 340143.27 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 571 |
| Number Of Beneficiaries Age 75 to 84 | 463 |
| Number Of Beneficiaries Age Greater 84 | 202 |
| Number Of Female Beneficiaries | 221 |
| Number Of Male Beneficiaries | 1079 |
| Number Of Non Hispanic White Beneficiaries | 1218 |
| Number Of Black or African American Beneficiaries | 19 |
| 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 | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1255 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 24 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1434 |