| National Provider Identifier [NPI]: | 1225097843 |
| Last Name Of The Provider | NISSEN |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1441 W CENTRAL PARK |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAVENPORT |
| Zip Code Of The Provider | 52804 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 8 |
| Number Of Services | 1816 |
| Number Of Medicare Beneficiaries | 459 |
| Total Submitted Charge Amount | 308256.75 |
| Total Medicare Allowed Amount | 88845.39 |
| Total Medicare Payment Amount | 57518.17 |
| Total Medicare Standardized Payment Amount | 63896.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 214 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 20001.75 |
| Total Drug Medicare AllowedAmount | 4356.21 |
| Total Drug Medicare PaymentAmount | 3306.02 |
| Total Drug Medicare Standardized Payment Amount | 3306.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 1602 |
| Number Of Medicare Beneficiaries With Medical Services | 459 |
| Total Medical Submitted Charge Amount | 288255 |
| Total Medical Medicare Allowed Amount | 84489.18 |
| Total Medical Medicare Payment Amount | 54212.15 |
| Total Medical Medicare Standardized Payment Amount | 60590.17 |
| Average Age Of Beneficiaries | 57 |
| Number Of Beneficiaries Age Less65 | 291 |
| Number Of Beneficiaries Age 65 to 74 | 126 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 234 |
| Number Of Male Beneficiaries | 225 |
| Number Of Non Hispanic White Beneficiaries | 404 |
| Number Of Black or African American Beneficiaries | 31 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 174 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 285 |
| Percent Of With Atrial Fibrillation | 3 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 63 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 40 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 2 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 37 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.166 |