| National Provider Identifier [NPI]: | 1497714406 |
| Last Name Of The Provider | WADE |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1020 TRUMP RD NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | CARROLLTON |
| Zip Code Of The Provider | 446158422 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 537 |
| Number Of Medicare Beneficiaries | 252 |
| Total Submitted Charge Amount | 61282 |
| Total Medicare Allowed Amount | 46409.2 |
| Total Medicare Payment Amount | 32348.59 |
| Total Medicare Standardized Payment Amount | 34256.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 1217 |
| Total Drug Medicare AllowedAmount | 935.78 |
| Total Drug Medicare PaymentAmount | 913.42 |
| Total Drug Medicare Standardized Payment Amount | 913.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 495 |
| Number Of Medicare Beneficiaries With Medical Services | 252 |
| Total Medical Submitted Charge Amount | 60065 |
| Total Medical Medicare Allowed Amount | 45473.42 |
| Total Medical Medicare Payment Amount | 31435.17 |
| Total Medical Medicare Standardized Payment Amount | 33342.93 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 114 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 151 |
| Number Of Male Beneficiaries | 101 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 204 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0396 |