| National Provider Identifier [NPI]: | 1154312080 |
| Last Name Of The Provider | OWENS |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2632 BROADWAY ST |
| Street Address 2 Of The Provider | SUITE 202 SOUTH |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782151137 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 5443 |
| Number Of Medicare Beneficiaries | 681 |
| Total Submitted Charge Amount | 454231.58 |
| Total Medicare Allowed Amount | 280908.23 |
| Total Medicare Payment Amount | 202884.95 |
| Total Medicare Standardized Payment Amount | 213384.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 141 |
| Number Of Medicare Beneficiaries With Drug Services | 64 |
| Total Drug Submitted ChargeAmount | 38773.02 |
| Total Drug Medicare AllowedAmount | 27794.58 |
| Total Drug Medicare PaymentAmount | 21387.44 |
| Total Drug Medicare Standardized Payment Amount | 21387.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 5302 |
| Number Of Medicare Beneficiaries With Medical Services | 681 |
| Total Medical Submitted Charge Amount | 415458.56 |
| Total Medical Medicare Allowed Amount | 253113.65 |
| Total Medical Medicare Payment Amount | 181497.51 |
| Total Medical Medicare Standardized Payment Amount | 191997.44 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 338 |
| Number Of Beneficiaries Age 75 to 84 | 218 |
| Number Of Beneficiaries Age Greater 84 | 87 |
| Number Of Female Beneficiaries | 381 |
| Number Of Male Beneficiaries | 300 |
| Number Of Non Hispanic White Beneficiaries | 583 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 648 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0054 |