| National Provider Identifier [NPI]: | 1952383226 |
| Last Name Of The Provider | SOTO |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1001 NOBLE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAIRBANKS |
| Zip Code Of The Provider | 997014922 |
| State Code Of The Provider | AK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 2752 |
| Number Of Medicare Beneficiaries | 553 |
| Total Submitted Charge Amount | 532735 |
| Total Medicare Allowed Amount | 238236.46 |
| Total Medicare Payment Amount | 173681.61 |
| Total Medicare Standardized Payment Amount | 145885.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 95 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 7818 |
| Total Drug Medicare AllowedAmount | 6944.09 |
| Total Drug Medicare PaymentAmount | 5444.08 |
| Total Drug Medicare Standardized Payment Amount | 5444.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 2657 |
| Number Of Medicare Beneficiaries With Medical Services | 553 |
| Total Medical Submitted Charge Amount | 524917 |
| Total Medical Medicare Allowed Amount | 231292.37 |
| Total Medical Medicare Payment Amount | 168237.53 |
| Total Medical Medicare Standardized Payment Amount | 140441.67 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 338 |
| Number Of Beneficiaries Age 75 to 84 | 134 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 303 |
| Number Of Male Beneficiaries | 250 |
| Number Of Non Hispanic White Beneficiaries | 497 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 27 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 492 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8065 |