| National Provider Identifier [NPI]: | 1699762336 |
| Last Name Of The Provider | NIKKEL |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5540 W 111TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OAK LAWN |
| Zip Code Of The Provider | 604535574 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 3284 |
| Number Of Medicare Beneficiaries | 448 |
| Total Submitted Charge Amount | 2569145 |
| Total Medicare Allowed Amount | 438297.81 |
| Total Medicare Payment Amount | 333856.12 |
| Total Medicare Standardized Payment Amount | 306239.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 502 |
| Number Of Medicare Beneficiaries With Drug Services | 164 |
| Total Drug Submitted ChargeAmount | 80575 |
| Total Drug Medicare AllowedAmount | 28213.18 |
| Total Drug Medicare PaymentAmount | 21488.34 |
| Total Drug Medicare Standardized Payment Amount | 21488.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 2782 |
| Number Of Medicare Beneficiaries With Medical Services | 448 |
| Total Medical Submitted Charge Amount | 2488570 |
| Total Medical Medicare Allowed Amount | 410084.63 |
| Total Medical Medicare Payment Amount | 312367.78 |
| Total Medical Medicare Standardized Payment Amount | 284751.21 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 56 |
| Number Of Beneficiaries Age 65 to 74 | 214 |
| Number Of Beneficiaries Age 75 to 84 | 141 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 274 |
| Number Of Male Beneficiaries | 174 |
| Number Of Non Hispanic White Beneficiaries | 327 |
| Number Of Black or African American Beneficiaries | 98 |
| 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 | 394 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9619 |