| National Provider Identifier [NPI]: | 1790939015 |
| Last Name Of The Provider | MCNICHOL |
| First Name Of The Provider | TJ |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4700 N HABANA AVE |
| Street Address 2 Of The Provider | SUITE 403 |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336147119 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 6728 |
| Number Of Medicare Beneficiaries | 1666 |
| Total Submitted Charge Amount | 240749.16 |
| Total Medicare Allowed Amount | 238154.83 |
| Total Medicare Payment Amount | 185039.19 |
| Total Medicare Standardized Payment Amount | 186110.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 26 |
| Number Of Drug Services | 1377 |
| Number Of Medicare Beneficiaries With Drug Services | 221 |
| Total Drug Submitted ChargeAmount | 2016.93 |
| Total Drug Medicare AllowedAmount | 1978.77 |
| Total Drug Medicare PaymentAmount | 1576.2 |
| Total Drug Medicare Standardized Payment Amount | 1576.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 65 |
| Number Of Medical Services | 5351 |
| Number Of Medicare Beneficiaries With Medical Services | 1666 |
| Total Medical Submitted Charge Amount | 238732.23 |
| Total Medical Medicare Allowed Amount | 236176.06 |
| Total Medical Medicare Payment Amount | 183462.99 |
| Total Medical Medicare Standardized Payment Amount | 184534.77 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 905 |
| Number Of Beneficiaries Age 75 to 84 | 544 |
| Number Of Beneficiaries Age Greater 84 | 150 |
| Number Of Female Beneficiaries | 971 |
| Number Of Male Beneficiaries | 695 |
| Number Of Non Hispanic White Beneficiaries | 1613 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1635 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0303 |