| National Provider Identifier [NPI]: | 1346298098 |
| Last Name Of The Provider | NICHOLS |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 N WILMOT |
| Street Address 2 Of The Provider | RINCON INTERNAL MEDICINE SUITE B250 |
| City Of The Provider | TUCSON |
| Zip Code Of The Provider | 85712 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 3270 |
| Number Of Medicare Beneficiaries | 208 |
| Total Submitted Charge Amount | 209763.5 |
| Total Medicare Allowed Amount | 109408.74 |
| Total Medicare Payment Amount | 82924.33 |
| Total Medicare Standardized Payment Amount | 83752.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 627 |
| Number Of Medicare Beneficiaries With Drug Services | 66 |
| Total Drug Submitted ChargeAmount | 3839.5 |
| Total Drug Medicare AllowedAmount | 1709.2 |
| Total Drug Medicare PaymentAmount | 1622.73 |
| Total Drug Medicare Standardized Payment Amount | 1622.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 2643 |
| Number Of Medicare Beneficiaries With Medical Services | 208 |
| Total Medical Submitted Charge Amount | 205924 |
| Total Medical Medicare Allowed Amount | 107699.54 |
| Total Medical Medicare Payment Amount | 81301.6 |
| Total Medical Medicare Standardized Payment Amount | 82130.15 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 94 |
| Number Of Beneficiaries Age 75 to 84 | 84 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 94 |
| Number Of Male Beneficiaries | 114 |
| Number Of Non Hispanic White Beneficiaries | 171 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 7 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8198 |