| National Provider Identifier [NPI]: | 1487692125 |
| Last Name Of The Provider | NICKOLISEN |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 601 W RIVERSIDE DR |
| Street Address 2 Of The Provider | SUITES 3 AND 4 |
| City Of The Provider | PARKER |
| Zip Code Of The Provider | 853445119 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 498 |
| Number Of Medicare Beneficiaries | 261 |
| Total Submitted Charge Amount | 94303 |
| Total Medicare Allowed Amount | 43615.24 |
| Total Medicare Payment Amount | 32332.76 |
| Total Medicare Standardized Payment Amount | 32511.02 |
| 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 | 33 |
| Number Of Medical Services | 498 |
| Number Of Medicare Beneficiaries With Medical Services | 261 |
| Total Medical Submitted Charge Amount | 94303 |
| Total Medical Medicare Allowed Amount | 43615.24 |
| Total Medical Medicare Payment Amount | 32332.76 |
| Total Medical Medicare Standardized Payment Amount | 32511.02 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 122 |
| Number Of Beneficiaries Age 75 to 84 | 90 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 94 |
| Number Of Male Beneficiaries | 167 |
| Number Of Non Hispanic White Beneficiaries | 94 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 108 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 237 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.0275 |