| National Provider Identifier [NPI]: | 1831151794 |
| Last Name Of The Provider | NELSON |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1035 116TH AVE NE |
| Street Address 2 Of The Provider | HOSPITALIST DEPT. |
| City Of The Provider | BELLEVUE |
| Zip Code Of The Provider | 980044604 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 216 |
| Number Of Medicare Beneficiaries | 92 |
| Total Submitted Charge Amount | 52371.43 |
| Total Medicare Allowed Amount | 21294.38 |
| Total Medicare Payment Amount | 16349.2 |
| Total Medicare Standardized Payment Amount | 15622.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 216 |
| Number Of Medicare Beneficiaries With Medical Services | 92 |
| Total Medical Submitted Charge Amount | 52371.43 |
| Total Medical Medicare Allowed Amount | 21294.38 |
| Total Medical Medicare Payment Amount | 16349.2 |
| Total Medical Medicare Standardized Payment Amount | 15622.55 |
| Average Age Of Beneficiaries | 81 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 52 |
| Number Of Male Beneficiaries | 40 |
| Number Of Non Hispanic White Beneficiaries | 81 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 75 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 50 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.9453 |