| National Provider Identifier [NPI]: | 1285684779 |
| Last Name Of The Provider | HAVEL |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5597 N DIXIE HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | OAKLAND PARK |
| Zip Code Of The Provider | 333343406 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 428 |
| Number Of Medicare Beneficiaries | 171 |
| Total Submitted Charge Amount | 27642 |
| Total Medicare Allowed Amount | 19373.1 |
| Total Medicare Payment Amount | 14205.87 |
| Total Medicare Standardized Payment Amount | 15949.34 |
| 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 | 10 |
| Number Of Medical Services | 428 |
| Number Of Medicare Beneficiaries With Medical Services | 171 |
| Total Medical Submitted Charge Amount | 27642 |
| Total Medical Medicare Allowed Amount | 19373.1 |
| Total Medical Medicare Payment Amount | 14205.87 |
| Total Medical Medicare Standardized Payment Amount | 15949.34 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 71 |
| Number Of Non Hispanic White Beneficiaries | 144 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 129 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7047 |