| National Provider Identifier [NPI]: | 1134111347 |
| Last Name Of The Provider | NICHOLS |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2424 W HOLCOMBE BLVD |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770301934 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 86 |
| Number Of Services | 9758 |
| Number Of Medicare Beneficiaries | 1177 |
| Total Submitted Charge Amount | 754858 |
| Total Medicare Allowed Amount | 515934.7 |
| Total Medicare Payment Amount | 383174.77 |
| Total Medicare Standardized Payment Amount | 381760.24 |
| 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 | 86 |
| Number Of Medical Services | 9758 |
| Number Of Medicare Beneficiaries With Medical Services | 1177 |
| Total Medical Submitted Charge Amount | 754858 |
| Total Medical Medicare Allowed Amount | 515934.7 |
| Total Medical Medicare Payment Amount | 383174.77 |
| Total Medical Medicare Standardized Payment Amount | 381760.24 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 348 |
| Number Of Beneficiaries Age 75 to 84 | 477 |
| Number Of Beneficiaries Age Greater 84 | 297 |
| Number Of Female Beneficiaries | 624 |
| Number Of Male Beneficiaries | 553 |
| Number Of Non Hispanic White Beneficiaries | 1084 |
| Number Of Black or African American Beneficiaries | 30 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1101 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1051 |