National Provider Identifier [NPI]: |
1609832237 |
Last Name Of The Provider |
NICHOLS |
First Name Of The Provider |
CAROL |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
541 FLOYD RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
SPARTANBURG |
Zip Code Of The Provider |
29307 |
State Code Of The Provider |
SC |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Neurology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
27 |
Number Of Services |
1723 |
Number Of Medicare Beneficiaries |
264 |
Total Submitted Charge Amount |
137723.8 |
Total Medicare Allowed Amount |
46548.97 |
Total Medicare Payment Amount |
33082.53 |
Total Medicare Standardized Payment Amount |
35986.23 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
1234 |
Number Of Medicare Beneficiaries With Drug Services |
11 |
Total Drug Submitted ChargeAmount |
12213.8 |
Total Drug Medicare AllowedAmount |
6637.47 |
Total Drug Medicare PaymentAmount |
4265.95 |
Total Drug Medicare Standardized Payment Amount |
4265.95 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
22 |
Number Of Medical Services |
489 |
Number Of Medicare Beneficiaries With Medical Services |
264 |
Total Medical Submitted Charge Amount |
125510 |
Total Medical Medicare Allowed Amount |
39911.5 |
Total Medical Medicare Payment Amount |
28816.58 |
Total Medical Medicare Standardized Payment Amount |
31720.28 |
Average Age Of Beneficiaries |
65 |
Number Of Beneficiaries Age Less65 |
101 |
Number Of Beneficiaries Age 65 to 74 |
83 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
196 |
Number Of Male Beneficiaries |
68 |
Number Of Non Hispanic White Beneficiaries |
231 |
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 |
202 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
62 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
55 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.1947 |