| National Provider Identifier [NPI]: | 1154304434 |
| Last Name Of The Provider | NIBLETT |
| First Name Of The Provider | RANDY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2209 GENESEE STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | UTICA |
| Zip Code Of The Provider | 135015930 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 218 |
| Number Of Services | 9002 |
| Number Of Medicare Beneficiaries | 6426 |
| Total Submitted Charge Amount | 919761.49 |
| Total Medicare Allowed Amount | 242995.22 |
| Total Medicare Payment Amount | 178730.09 |
| Total Medicare Standardized Payment Amount | 189288.86 |
| 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 | 218 |
| Number Of Medical Services | 9002 |
| Number Of Medicare Beneficiaries With Medical Services | 6426 |
| Total Medical Submitted Charge Amount | 919761.49 |
| Total Medical Medicare Allowed Amount | 242995.22 |
| Total Medical Medicare Payment Amount | 178730.09 |
| Total Medical Medicare Standardized Payment Amount | 189288.86 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1451 |
| Number Of Beneficiaries Age 65 to 74 | 2322 |
| Number Of Beneficiaries Age 75 to 84 | 1725 |
| Number Of Beneficiaries Age Greater 84 | 928 |
| Number Of Female Beneficiaries | 3921 |
| Number Of Male Beneficiaries | 2505 |
| Number Of Non Hispanic White Beneficiaries | 4789 |
| Number Of Black or African American Beneficiaries | 290 |
| Number Of AsianPacific Islander Beneficiaries | 29 |
| Number Of Hispanic Beneficiaries | 83 |
| Number Of American Indian Alaska Native Beneficiaries | 1201 |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4134 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2292 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6218 |