| National Provider Identifier [NPI]: | 1306839667 |
| Last Name Of The Provider | NICHOLSON |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 901 MACARTHUR BLVD |
| Street Address 2 Of The Provider | MUNSTER RADIOLOGY GROUP |
| City Of The Provider | MUNSTER |
| Zip Code Of The Provider | 463212901 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 11332 |
| Number Of Medicare Beneficiaries | 5001 |
| Total Submitted Charge Amount | 1071256.13 |
| Total Medicare Allowed Amount | 244851.44 |
| Total Medicare Payment Amount | 217693.59 |
| Total Medicare Standardized Payment Amount | 227672.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 11332 |
| Number Of Medicare Beneficiaries With Medical Services | 5001 |
| Total Medical Submitted Charge Amount | 1071256.13 |
| Total Medical Medicare Allowed Amount | 244851.44 |
| Total Medical Medicare Payment Amount | 217693.59 |
| Total Medical Medicare Standardized Payment Amount | 227672.62 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 496 |
| Number Of Beneficiaries Age 65 to 74 | 2626 |
| Number Of Beneficiaries Age 75 to 84 | 1528 |
| Number Of Beneficiaries Age Greater 84 | 351 |
| Number Of Female Beneficiaries | 4965 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 3723 |
| Number Of Black or African American Beneficiaries | 612 |
| Number Of AsianPacific Islander Beneficiaries | 37 |
| Number Of Hispanic Beneficiaries | 595 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 4440 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 561 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9594 |