| National Provider Identifier [NPI]: | 1790750115 |
| Last Name Of The Provider | MCNICOLL |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2876 SYCAMORE DR |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | SIMI VALLEY |
| Zip Code Of The Provider | 930651550 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 151 |
| Number Of Services | 6211 |
| Number Of Medicare Beneficiaries | 595 |
| Total Submitted Charge Amount | 962765 |
| Total Medicare Allowed Amount | 475788.26 |
| Total Medicare Payment Amount | 354667.05 |
| Total Medicare Standardized Payment Amount | 330279.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 434 |
| Number Of Medicare Beneficiaries With Drug Services | 197 |
| Total Drug Submitted ChargeAmount | 18215 |
| Total Drug Medicare AllowedAmount | 8137.91 |
| Total Drug Medicare PaymentAmount | 7367.19 |
| Total Drug Medicare Standardized Payment Amount | 7367.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 135 |
| Number Of Medical Services | 5777 |
| Number Of Medicare Beneficiaries With Medical Services | 595 |
| Total Medical Submitted Charge Amount | 944550 |
| Total Medical Medicare Allowed Amount | 467650.35 |
| Total Medical Medicare Payment Amount | 347299.86 |
| Total Medical Medicare Standardized Payment Amount | 322911.85 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 274 |
| Number Of Beneficiaries Age 75 to 84 | 154 |
| Number Of Beneficiaries Age Greater 84 | 99 |
| Number Of Female Beneficiaries | 345 |
| Number Of Male Beneficiaries | 250 |
| Number Of Non Hispanic White Beneficiaries | 497 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 57 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 503 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 92 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.0388 |