| National Provider Identifier [NPI]: | 1467452342 |
| Last Name Of The Provider | NICKNISH |
| First Name Of The Provider | THOMAS |
| 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 | 2460 TOWNCREST DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | IOWA CITY |
| Zip Code Of The Provider | 522406622 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 3153 |
| Number Of Medicare Beneficiaries | 255 |
| Total Submitted Charge Amount | 160415.8 |
| Total Medicare Allowed Amount | 72610.78 |
| Total Medicare Payment Amount | 54338.03 |
| Total Medicare Standardized Payment Amount | 57694.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 146 |
| Number Of Medicare Beneficiaries With Drug Services | 130 |
| Total Drug Submitted ChargeAmount | 4439 |
| Total Drug Medicare AllowedAmount | 3747.45 |
| Total Drug Medicare PaymentAmount | 3668.27 |
| Total Drug Medicare Standardized Payment Amount | 3668.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 3007 |
| Number Of Medicare Beneficiaries With Medical Services | 255 |
| Total Medical Submitted Charge Amount | 155976.8 |
| Total Medical Medicare Allowed Amount | 68863.33 |
| Total Medical Medicare Payment Amount | 50669.76 |
| Total Medical Medicare Standardized Payment Amount | 54026.08 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 106 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 108 |
| Number Of Male Beneficiaries | 147 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 7 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 43 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.778 |