| National Provider Identifier [NPI]: | 1356387484 |
| Last Name Of The Provider | NICHOLAS |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3202 MCINTOSH CIR |
| Street Address 2 Of The Provider | STE LL03 |
| City Of The Provider | JOPLIN |
| Zip Code Of The Provider | 648043646 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 211 |
| Number Of Services | 13632 |
| Number Of Medicare Beneficiaries | 4012 |
| Total Submitted Charge Amount | 3411862.98 |
| Total Medicare Allowed Amount | 1153285.39 |
| Total Medicare Payment Amount | 863054.09 |
| Total Medicare Standardized Payment Amount | 920122.51 |
| 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 | 211 |
| Number Of Medical Services | 13632 |
| Number Of Medicare Beneficiaries With Medical Services | 4012 |
| Total Medical Submitted Charge Amount | 3411862.98 |
| Total Medical Medicare Allowed Amount | 1153285.39 |
| Total Medical Medicare Payment Amount | 863054.09 |
| Total Medical Medicare Standardized Payment Amount | 920122.51 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 610 |
| Number Of Beneficiaries Age 65 to 74 | 1549 |
| Number Of Beneficiaries Age 75 to 84 | 1267 |
| Number Of Beneficiaries Age Greater 84 | 586 |
| Number Of Female Beneficiaries | 2091 |
| Number Of Male Beneficiaries | 1921 |
| Number Of Non Hispanic White Beneficiaries | 3773 |
| Number Of Black or African American Beneficiaries | 64 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | 94 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3150 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 862 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5358 |