| National Provider Identifier [NPI]: | 1053388785 |
| Last Name Of The Provider | NICKELL |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7777 SOUTHWEST FWY |
| Street Address 2 Of The Provider | # 1032 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770741802 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 4380 |
| Number Of Medicare Beneficiaries | 838 |
| Total Submitted Charge Amount | 343144.36 |
| Total Medicare Allowed Amount | 304571.74 |
| Total Medicare Payment Amount | 225069.46 |
| Total Medicare Standardized Payment Amount | 228288.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 522 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 66309.54 |
| Total Drug Medicare AllowedAmount | 64203.64 |
| Total Drug Medicare PaymentAmount | 50061.6 |
| Total Drug Medicare Standardized Payment Amount | 50061.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 98 |
| Number Of Medical Services | 3858 |
| Number Of Medicare Beneficiaries With Medical Services | 838 |
| Total Medical Submitted Charge Amount | 276834.82 |
| Total Medical Medicare Allowed Amount | 240368.1 |
| Total Medical Medicare Payment Amount | 175007.86 |
| Total Medical Medicare Standardized Payment Amount | 178226.99 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 361 |
| Number Of Beneficiaries Age 75 to 84 | 297 |
| Number Of Beneficiaries Age Greater 84 | 123 |
| Number Of Female Beneficiaries | 237 |
| Number Of Male Beneficiaries | 601 |
| Number Of Non Hispanic White Beneficiaries | 634 |
| Number Of Black or African American Beneficiaries | 74 |
| Number Of AsianPacific Islander Beneficiaries | 56 |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 755 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2123 |