| National Provider Identifier [NPI]: | 1629292883 |
| Last Name Of The Provider | WILLIS |
| First Name Of The Provider | NICHOLAS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1601 W 40TH AVE |
| Street Address 2 Of The Provider | SUITE 301 |
| City Of The Provider | PINE BLUFF |
| Zip Code Of The Provider | 716036319 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 90 |
| Number Of Services | 8072 |
| Number Of Medicare Beneficiaries | 1667 |
| Total Submitted Charge Amount | 920517.75 |
| Total Medicare Allowed Amount | 441118.68 |
| Total Medicare Payment Amount | 328236.77 |
| Total Medicare Standardized Payment Amount | 356198 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 8072 |
| Number Of Medicare Beneficiaries With Medical Services | 1667 |
| Total Medical Submitted Charge Amount | 920517.75 |
| Total Medical Medicare Allowed Amount | 441118.68 |
| Total Medical Medicare Payment Amount | 328236.77 |
| Total Medical Medicare Standardized Payment Amount | 356198 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 327 |
| Number Of Beneficiaries Age 65 to 74 | 615 |
| Number Of Beneficiaries Age 75 to 84 | 465 |
| Number Of Beneficiaries Age Greater 84 | 260 |
| Number Of Female Beneficiaries | 898 |
| Number Of Male Beneficiaries | 769 |
| Number Of Non Hispanic White Beneficiaries | 1155 |
| Number Of Black or African American Beneficiaries | 498 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1098 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 569 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 51 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 72 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7785 |