| National Provider Identifier [NPI]: | 1003811415 |
| Last Name Of The Provider | NIELSEN |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 702 DAVIS ST |
| Street Address 2 Of The Provider | STE 4 |
| City Of The Provider | CARTHAGE |
| Zip Code Of The Provider | 756331461 |
| 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 | 19 |
| Number Of Services | 1670 |
| Number Of Medicare Beneficiaries | 400 |
| Total Submitted Charge Amount | 139414.94 |
| Total Medicare Allowed Amount | 138106.22 |
| Total Medicare Payment Amount | 88260.1 |
| Total Medicare Standardized Payment Amount | 96100.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 112 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 290.23 |
| Total Drug Medicare AllowedAmount | 162.69 |
| Total Drug Medicare PaymentAmount | 132.22 |
| Total Drug Medicare Standardized Payment Amount | 132.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 1558 |
| Number Of Medicare Beneficiaries With Medical Services | 400 |
| Total Medical Submitted Charge Amount | 139124.71 |
| Total Medical Medicare Allowed Amount | 137943.53 |
| Total Medical Medicare Payment Amount | 88127.88 |
| Total Medical Medicare Standardized Payment Amount | 95968.11 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 175 |
| Number Of Beneficiaries Age 75 to 84 | 131 |
| Number Of Beneficiaries Age Greater 84 | 60 |
| Number Of Female Beneficiaries | 247 |
| Number Of Male Beneficiaries | 153 |
| Number Of Non Hispanic White Beneficiaries | 355 |
| 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 | 340 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 0.9017 |