| National Provider Identifier [NPI]: | 1598074353 |
| Last Name Of The Provider | GILLETTE |
| First Name Of The Provider | NICKOLAS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1611 S BALTIMORE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | KIRKSVILLE |
| Zip Code Of The Provider | 635014536 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 152 |
| Number Of Services | 5843.5 |
| Number Of Medicare Beneficiaries | 313 |
| Total Submitted Charge Amount | 446953 |
| Total Medicare Allowed Amount | 217590.77 |
| Total Medicare Payment Amount | 166553.46 |
| Total Medicare Standardized Payment Amount | 176886.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 465.5 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 6274 |
| Total Drug Medicare AllowedAmount | 2624.12 |
| Total Drug Medicare PaymentAmount | 2175.03 |
| Total Drug Medicare Standardized Payment Amount | 2175.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 135 |
| Number Of Medical Services | 5378 |
| Number Of Medicare Beneficiaries With Medical Services | 313 |
| Total Medical Submitted Charge Amount | 440679 |
| Total Medical Medicare Allowed Amount | 214966.65 |
| Total Medical Medicare Payment Amount | 164378.43 |
| Total Medical Medicare Standardized Payment Amount | 174711.45 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 119 |
| Number Of Beneficiaries Age 65 to 74 | 105 |
| Number Of Beneficiaries Age 75 to 84 | 56 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 182 |
| Number Of Male Beneficiaries | 131 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 180 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 133 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2588 |