| National Provider Identifier [NPI]: | 1770572760 |
| Last Name Of The Provider | NICKAS |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 20055 LAKE CHABOT RD |
| Street Address 2 Of The Provider | #100 |
| City Of The Provider | CASTRO VALLEY |
| Zip Code Of The Provider | 945465331 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 1594 |
| Number Of Medicare Beneficiaries | 541 |
| Total Submitted Charge Amount | 380732.08 |
| Total Medicare Allowed Amount | 213222.2 |
| Total Medicare Payment Amount | 157814.54 |
| Total Medicare Standardized Payment Amount | 143476.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 256 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 131982.32 |
| Total Drug Medicare AllowedAmount | 50419.58 |
| Total Drug Medicare PaymentAmount | 38553.53 |
| Total Drug Medicare Standardized Payment Amount | 38553.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 1338 |
| Number Of Medicare Beneficiaries With Medical Services | 541 |
| Total Medical Submitted Charge Amount | 248749.76 |
| Total Medical Medicare Allowed Amount | 162802.62 |
| Total Medical Medicare Payment Amount | 119261.01 |
| Total Medical Medicare Standardized Payment Amount | 104922.49 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 168 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 158 |
| Number Of Female Beneficiaries | 123 |
| Number Of Male Beneficiaries | 418 |
| Number Of Non Hispanic White Beneficiaries | 413 |
| Number Of Black or African American Beneficiaries | 34 |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 57 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 501 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 73 |
| 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 | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2912 |