| National Provider Identifier [NPI]: | 1528032356 |
| Last Name Of The Provider | NICOL |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 JOHNSON FERRY RD NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ATLANTA |
| Zip Code Of The Provider | 303421606 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 4946 |
| Number Of Medicare Beneficiaries | 2676 |
| Total Submitted Charge Amount | 577390 |
| Total Medicare Allowed Amount | 122893.67 |
| Total Medicare Payment Amount | 93291.47 |
| Total Medicare Standardized Payment Amount | 94587.04 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 325 |
| Number Of Beneficiaries Age 65 to 74 | 1122 |
| Number Of Beneficiaries Age 75 to 84 | 802 |
| Number Of Beneficiaries Age Greater 84 | 427 |
| Number Of Female Beneficiaries | 1679 |
| Number Of Male Beneficiaries | 997 |
| Number Of Non Hispanic White Beneficiaries | 2294 |
| Number Of Black or African American Beneficiaries | 227 |
| Number Of AsianPacific Islander Beneficiaries | 59 |
| Number Of Hispanic Beneficiaries | 60 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2239 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 437 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.721 |