| National Provider Identifier [NPI]: | 1730118431 |
| Last Name Of The Provider | DILLON |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 20 HOSPITAL DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOGAN |
| Zip Code Of The Provider | 256010000 |
| State Code Of The Provider | WV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 834 |
| Number Of Medicare Beneficiaries | 211 |
| Total Submitted Charge Amount | 143305.88 |
| Total Medicare Allowed Amount | 69042.27 |
| Total Medicare Payment Amount | 46308.75 |
| Total Medicare Standardized Payment Amount | 50652.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 2053.88 |
| Total Drug Medicare AllowedAmount | 1160.17 |
| Total Drug Medicare PaymentAmount | 1130.13 |
| Total Drug Medicare Standardized Payment Amount | 1130.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 758 |
| Number Of Medicare Beneficiaries With Medical Services | 211 |
| Total Medical Submitted Charge Amount | 141252 |
| Total Medical Medicare Allowed Amount | 67882.1 |
| Total Medical Medicare Payment Amount | 45178.62 |
| Total Medical Medicare Standardized Payment Amount | 49522.26 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 86 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 126 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 139 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 72 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9822 |