| National Provider Identifier [NPI]: | 1104179449 |
| Last Name Of The Provider | CHARLES |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16261 BASS RD |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339083671 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 1009 |
| Number Of Medicare Beneficiaries | 664 |
| Total Submitted Charge Amount | 150659 |
| Total Medicare Allowed Amount | 50446.76 |
| Total Medicare Payment Amount | 38016.07 |
| Total Medicare Standardized Payment Amount | 42896.59 |
| 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 | 1009 |
| Number Of Medicare Beneficiaries With Medical Services | 664 |
| Total Medical Submitted Charge Amount | 150659 |
| Total Medical Medicare Allowed Amount | 50446.76 |
| Total Medical Medicare Payment Amount | 38016.07 |
| Total Medical Medicare Standardized Payment Amount | 42896.59 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 223 |
| Number Of Beneficiaries Age 75 to 84 | 273 |
| Number Of Beneficiaries Age Greater 84 | 144 |
| Number Of Female Beneficiaries | 295 |
| Number Of Male Beneficiaries | 369 |
| Number Of Non Hispanic White Beneficiaries | 629 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 633 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 48 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6212 |