| National Provider Identifier [NPI]: | 1831151208 |
| Last Name Of The Provider | NICKESON |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6807 EMMETT F LOWRY EXPRESSWAY |
| Street Address 2 Of The Provider | SUITE 303 |
| City Of The Provider | TEXAS CITY |
| Zip Code Of The Provider | 775912543 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 3834 |
| Number Of Medicare Beneficiaries | 666 |
| Total Submitted Charge Amount | 697019 |
| Total Medicare Allowed Amount | 372212.52 |
| Total Medicare Payment Amount | 286791.12 |
| Total Medicare Standardized Payment Amount | 284188.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 38 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 1068 |
| Total Drug Medicare AllowedAmount | 466.39 |
| Total Drug Medicare PaymentAmount | 448.5 |
| Total Drug Medicare Standardized Payment Amount | 448.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 3796 |
| Number Of Medicare Beneficiaries With Medical Services | 666 |
| Total Medical Submitted Charge Amount | 695951 |
| Total Medical Medicare Allowed Amount | 371746.13 |
| Total Medical Medicare Payment Amount | 286342.62 |
| Total Medical Medicare Standardized Payment Amount | 283739.58 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 106 |
| Number Of Beneficiaries Age 65 to 74 | 221 |
| Number Of Beneficiaries Age 75 to 84 | 208 |
| Number Of Beneficiaries Age Greater 84 | 131 |
| Number Of Female Beneficiaries | 381 |
| Number Of Male Beneficiaries | 285 |
| Number Of Non Hispanic White Beneficiaries | 468 |
| Number Of Black or African American Beneficiaries | 137 |
| 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 | 461 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 205 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 34 |
| Percent Of With Asthma | 23 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 65 |
| Percent Of With Chronic Kidney Disease | 65 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 60 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 3.0002 |