| National Provider Identifier [NPI]: | 1902085178 |
| Last Name Of The Provider | NICOL |
| First Name Of The Provider | EWEN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 E MEDICAL CENTER DR |
| Street Address 2 Of The Provider | B1 FLOOR UNIVERSITY HOSPITAL RECP C |
| City Of The Provider | ANN ARBOR |
| Zip Code Of The Provider | 481090030 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 3688 |
| Number Of Medicare Beneficiaries | 563 |
| Total Submitted Charge Amount | 624238 |
| Total Medicare Allowed Amount | 268162.04 |
| Total Medicare Payment Amount | 205240.43 |
| Total Medicare Standardized Payment Amount | 238927.57 |
| 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 | 12 |
| Number Of Medical Services | 3688 |
| Number Of Medicare Beneficiaries With Medical Services | 563 |
| Total Medical Submitted Charge Amount | 624238 |
| Total Medical Medicare Allowed Amount | 268162.04 |
| Total Medical Medicare Payment Amount | 205240.43 |
| Total Medical Medicare Standardized Payment Amount | 238927.57 |
| Average Age Of Beneficiaries | 81 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 91 |
| Number Of Beneficiaries Age 75 to 84 | 214 |
| Number Of Beneficiaries Age Greater 84 | 228 |
| Number Of Female Beneficiaries | 366 |
| Number Of Male Beneficiaries | 197 |
| Number Of Non Hispanic White Beneficiaries | 541 |
| Number Of Black or African American Beneficiaries | |
| 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 | 438 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 125 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 51 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 57 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.2383 |