| National Provider Identifier [NPI]: | 1366486144 |
| Last Name Of The Provider | NICA |
| First Name Of The Provider | ROMANITA |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1003 DIVISION ST |
| Street Address 2 Of The Provider | SUITE 5 |
| City Of The Provider | PRESCOTT |
| Zip Code Of The Provider | 863011657 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 36164 |
| Number Of Medicare Beneficiaries | 995 |
| Total Submitted Charge Amount | 1221901 |
| Total Medicare Allowed Amount | 611229.3 |
| Total Medicare Payment Amount | 458641.06 |
| Total Medicare Standardized Payment Amount | 464189.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 31387 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 106687 |
| Total Drug Medicare AllowedAmount | 51204.69 |
| Total Drug Medicare PaymentAmount | 39971.6 |
| Total Drug Medicare Standardized Payment Amount | 39971.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 4777 |
| Number Of Medicare Beneficiaries With Medical Services | 995 |
| Total Medical Submitted Charge Amount | 1115214 |
| Total Medical Medicare Allowed Amount | 560024.61 |
| Total Medical Medicare Payment Amount | 418669.46 |
| Total Medical Medicare Standardized Payment Amount | 424217.96 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 112 |
| Number Of Beneficiaries Age 65 to 74 | 350 |
| Number Of Beneficiaries Age 75 to 84 | 391 |
| Number Of Beneficiaries Age Greater 84 | 142 |
| Number Of Female Beneficiaries | 495 |
| Number Of Male Beneficiaries | 500 |
| Number Of Non Hispanic White Beneficiaries | 912 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 881 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 114 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 2.4317 |