| National Provider Identifier [NPI]: | 1467425330 |
| Last Name Of The Provider | IVERSON |
| First Name Of The Provider | NICHOL |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1701 3RD ST SE |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | PUYALLUP |
| Zip Code Of The Provider | 983724511 |
| 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 | 26 |
| Number Of Services | 1644 |
| Number Of Medicare Beneficiaries | 791 |
| Total Submitted Charge Amount | 210634 |
| Total Medicare Allowed Amount | 101480.65 |
| Total Medicare Payment Amount | 68307.76 |
| Total Medicare Standardized Payment Amount | 69706.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 49 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 2479 |
| Total Drug Medicare AllowedAmount | 2246.87 |
| Total Drug Medicare PaymentAmount | 2199.23 |
| Total Drug Medicare Standardized Payment Amount | 2199.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1595 |
| Number Of Medicare Beneficiaries With Medical Services | 791 |
| Total Medical Submitted Charge Amount | 208155 |
| Total Medical Medicare Allowed Amount | 99233.78 |
| Total Medical Medicare Payment Amount | 66108.53 |
| Total Medical Medicare Standardized Payment Amount | 67507.22 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 115 |
| Number Of Beneficiaries Age 65 to 74 | 298 |
| Number Of Beneficiaries Age 75 to 84 | 251 |
| Number Of Beneficiaries Age Greater 84 | 127 |
| Number Of Female Beneficiaries | 405 |
| Number Of Male Beneficiaries | 386 |
| Number Of Non Hispanic White Beneficiaries | 730 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 665 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 126 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6374 |