| National Provider Identifier [NPI]: | 1215983572 |
| Last Name Of The Provider | NIVENS |
| First Name Of The Provider | JAMIE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2210 N HWY 360 |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND PRAIRIE |
| Zip Code Of The Provider | 750501017 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 1287 |
| Number Of Medicare Beneficiaries | 142 |
| Total Submitted Charge Amount | 89591.04 |
| Total Medicare Allowed Amount | 48490.53 |
| Total Medicare Payment Amount | 30285.59 |
| Total Medicare Standardized Payment Amount | 34244.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 257 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 5483.48 |
| Total Drug Medicare AllowedAmount | 2767.3 |
| Total Drug Medicare PaymentAmount | 2243.99 |
| Total Drug Medicare Standardized Payment Amount | 2243.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 1030 |
| Number Of Medicare Beneficiaries With Medical Services | 142 |
| Total Medical Submitted Charge Amount | 84107.56 |
| Total Medical Medicare Allowed Amount | 45723.23 |
| Total Medical Medicare Payment Amount | 28041.6 |
| Total Medical Medicare Standardized Payment Amount | 32000.98 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 72 |
| Number Of Male Beneficiaries | 70 |
| Number Of Non Hispanic White Beneficiaries | 104 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 131 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9264 |