| National Provider Identifier [NPI]: | 1225009608 |
| Last Name Of The Provider | NICHOLS |
| First Name Of The Provider | LARRY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 590 S MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SNOWFLAKE |
| Zip Code Of The Provider | 85937 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 2272 |
| Number Of Medicare Beneficiaries | 496 |
| Total Submitted Charge Amount | 211777 |
| Total Medicare Allowed Amount | 114702.67 |
| Total Medicare Payment Amount | 75771.76 |
| Total Medicare Standardized Payment Amount | 77721 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 353 |
| Number Of Medicare Beneficiaries With Drug Services | 74 |
| Total Drug Submitted ChargeAmount | 3793 |
| Total Drug Medicare AllowedAmount | 1546.59 |
| Total Drug Medicare PaymentAmount | 1316.3 |
| Total Drug Medicare Standardized Payment Amount | 1316.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 1919 |
| Number Of Medicare Beneficiaries With Medical Services | 496 |
| Total Medical Submitted Charge Amount | 207984 |
| Total Medical Medicare Allowed Amount | 113156.08 |
| Total Medical Medicare Payment Amount | 74455.46 |
| Total Medical Medicare Standardized Payment Amount | 76404.7 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 223 |
| Number Of Beneficiaries Age 75 to 84 | 152 |
| Number Of Beneficiaries Age Greater 84 | 57 |
| Number Of Female Beneficiaries | 268 |
| Number Of Male Beneficiaries | 228 |
| Number Of Non Hispanic White Beneficiaries | 406 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 55 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 380 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 116 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1574 |