| National Provider Identifier [NPI]: | 1699889865 |
| Last Name Of The Provider | CARBONELL |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3950 AUSTELL RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUSTELL |
| Zip Code Of The Provider | 301061121 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 908 |
| Number Of Medicare Beneficiaries | 604 |
| Total Submitted Charge Amount | 568021 |
| Total Medicare Allowed Amount | 100785.21 |
| Total Medicare Payment Amount | 76646.43 |
| Total Medicare Standardized Payment Amount | 76790.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 130 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 5300 |
| Total Drug Medicare AllowedAmount | 199.95 |
| Total Drug Medicare PaymentAmount | 181.51 |
| Total Drug Medicare Standardized Payment Amount | 181.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 778 |
| Number Of Medicare Beneficiaries With Medical Services | 602 |
| Total Medical Submitted Charge Amount | 562721 |
| Total Medical Medicare Allowed Amount | 100585.26 |
| Total Medical Medicare Payment Amount | 76464.92 |
| Total Medical Medicare Standardized Payment Amount | 76609.4 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 100 |
| Number Of Beneficiaries Age 65 to 74 | 218 |
| Number Of Beneficiaries Age 75 to 84 | 171 |
| Number Of Beneficiaries Age Greater 84 | 115 |
| Number Of Female Beneficiaries | 359 |
| Number Of Male Beneficiaries | 245 |
| Number Of Non Hispanic White Beneficiaries | 504 |
| Number Of Black or African American Beneficiaries | 78 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 495 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7697 |