| National Provider Identifier [NPI]: | 1568803369 |
| Last Name Of The Provider | DORNICIK |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | AU.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 292 SHADE TREE LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | RIVERHEAD |
| Zip Code Of The Provider | 119015020 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Audiologist (billing independently) |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 1215 |
| Number Of Medicare Beneficiaries | 520 |
| Total Submitted Charge Amount | 94962 |
| Total Medicare Allowed Amount | 38156.22 |
| Total Medicare Payment Amount | 29134.75 |
| Total Medicare Standardized Payment Amount | 24196.54 |
| 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 | 1215 |
| Number Of Medicare Beneficiaries With Medical Services | 520 |
| Total Medical Submitted Charge Amount | 94962 |
| Total Medical Medicare Allowed Amount | 38156.22 |
| Total Medical Medicare Payment Amount | 29134.75 |
| Total Medical Medicare Standardized Payment Amount | 24196.54 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 198 |
| Number Of Beneficiaries Age 75 to 84 | 158 |
| Number Of Beneficiaries Age Greater 84 | 84 |
| Number Of Female Beneficiaries | 283 |
| Number Of Male Beneficiaries | 237 |
| Number Of Non Hispanic White Beneficiaries | 484 |
| Number Of Black or African American Beneficiaries | 16 |
| 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 | 412 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 108 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.127 |