| National Provider Identifier [NPI]: | 1053496422 |
| Last Name Of The Provider | NICHOLS |
| First Name Of The Provider | ANDREA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 178 SUNRISE HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROCKVILLE CENTRE |
| Zip Code Of The Provider | 115704704 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 723 |
| Number Of Medicare Beneficiaries | 201 |
| Total Submitted Charge Amount | 64644.18 |
| Total Medicare Allowed Amount | 35186.35 |
| Total Medicare Payment Amount | 27996.82 |
| Total Medicare Standardized Payment Amount | 24657.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 109 |
| Number Of Medicare Beneficiaries With Drug Services | 105 |
| Total Drug Submitted ChargeAmount | 2374.68 |
| Total Drug Medicare AllowedAmount | 2143.98 |
| Total Drug Medicare PaymentAmount | 2101.05 |
| Total Drug Medicare Standardized Payment Amount | 2101.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 614 |
| Number Of Medicare Beneficiaries With Medical Services | 201 |
| Total Medical Submitted Charge Amount | 62269.5 |
| Total Medical Medicare Allowed Amount | 33042.37 |
| Total Medical Medicare Payment Amount | 25895.77 |
| Total Medical Medicare Standardized Payment Amount | 22556.15 |
| Average Age Of Beneficiaries | 44 |
| Number Of Beneficiaries Age Less65 | 179 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 82 |
| Number Of Male Beneficiaries | 119 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 70 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 77 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 0 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 201 |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 25 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 29 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8928 |