| National Provider Identifier [NPI]: | 1821391533 |
| Last Name Of The Provider | NICHOLS |
| First Name Of The Provider | MACKENZIE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 130 N 7TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SLATON |
| Zip Code Of The Provider | 793644266 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 2735 |
| Number Of Medicare Beneficiaries | 249 |
| Total Submitted Charge Amount | 153252 |
| Total Medicare Allowed Amount | 64885.83 |
| Total Medicare Payment Amount | 43094.92 |
| Total Medicare Standardized Payment Amount | 53744.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 1163 |
| Number Of Medicare Beneficiaries With Drug Services | 156 |
| Total Drug Submitted ChargeAmount | 20649 |
| Total Drug Medicare AllowedAmount | 3298.81 |
| Total Drug Medicare PaymentAmount | 2388.68 |
| Total Drug Medicare Standardized Payment Amount | 2388.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 1572 |
| Number Of Medicare Beneficiaries With Medical Services | 249 |
| Total Medical Submitted Charge Amount | 132603 |
| Total Medical Medicare Allowed Amount | 61587.02 |
| Total Medical Medicare Payment Amount | 40706.24 |
| Total Medical Medicare Standardized Payment Amount | 51355.41 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 100 |
| Number Of Beneficiaries Age 75 to 84 | 75 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 148 |
| Number Of Male Beneficiaries | 101 |
| Number Of Non Hispanic White Beneficiaries | 174 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 209 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9146 |