| National Provider Identifier [NPI]: | 1841226909 |
| Last Name Of The Provider | NICOLIS |
| First Name Of The Provider | CARLO |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 STATE STREET |
| Street Address 2 Of The Provider | SUITE 205 |
| City Of The Provider | MEDIA |
| Zip Code Of The Provider | 190633434 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 88 |
| Number Of Services | 6850 |
| Number Of Medicare Beneficiaries | 962 |
| Total Submitted Charge Amount | 1396546.61 |
| Total Medicare Allowed Amount | 413709.14 |
| Total Medicare Payment Amount | 306802.03 |
| Total Medicare Standardized Payment Amount | 294488.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 1748 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 127916.45 |
| Total Drug Medicare AllowedAmount | 31855.12 |
| Total Drug Medicare PaymentAmount | 24050.01 |
| Total Drug Medicare Standardized Payment Amount | 24050.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 5102 |
| Number Of Medicare Beneficiaries With Medical Services | 962 |
| Total Medical Submitted Charge Amount | 1268630.16 |
| Total Medical Medicare Allowed Amount | 381854.02 |
| Total Medical Medicare Payment Amount | 282752.02 |
| Total Medical Medicare Standardized Payment Amount | 270438.5 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 133 |
| Number Of Beneficiaries Age 65 to 74 | 352 |
| Number Of Beneficiaries Age 75 to 84 | 280 |
| Number Of Beneficiaries Age Greater 84 | 197 |
| Number Of Female Beneficiaries | 282 |
| Number Of Male Beneficiaries | 680 |
| Number Of Non Hispanic White Beneficiaries | 762 |
| Number Of Black or African American Beneficiaries | 173 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 747 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 215 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.6324 |