| National Provider Identifier [NPI]: | 1245331230 |
| Last Name Of The Provider | NICPON |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3156 VISTA WAY |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | OCEANSIDE |
| Zip Code Of The Provider | 920563622 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 162 |
| Number Of Services | 12059 |
| Number Of Medicare Beneficiaries | 2742 |
| Total Submitted Charge Amount | 1232577.88 |
| Total Medicare Allowed Amount | 303667.29 |
| Total Medicare Payment Amount | 228787.93 |
| Total Medicare Standardized Payment Amount | 221793.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 7681 |
| Number Of Medicare Beneficiaries With Drug Services | 123 |
| Total Drug Submitted ChargeAmount | 19739.48 |
| Total Drug Medicare AllowedAmount | 3183.13 |
| Total Drug Medicare PaymentAmount | 2495.58 |
| Total Drug Medicare Standardized Payment Amount | 2495.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 160 |
| Number Of Medical Services | 4378 |
| Number Of Medicare Beneficiaries With Medical Services | 2742 |
| Total Medical Submitted Charge Amount | 1212838.4 |
| Total Medical Medicare Allowed Amount | 300484.16 |
| Total Medical Medicare Payment Amount | 226292.35 |
| Total Medical Medicare Standardized Payment Amount | 219297.67 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 413 |
| Number Of Beneficiaries Age 65 to 74 | 857 |
| Number Of Beneficiaries Age 75 to 84 | 841 |
| Number Of Beneficiaries Age Greater 84 | 631 |
| Number Of Female Beneficiaries | 1577 |
| Number Of Male Beneficiaries | 1165 |
| Number Of Non Hispanic White Beneficiaries | 2121 |
| Number Of Black or African American Beneficiaries | 73 |
| Number Of AsianPacific Islander Beneficiaries | 152 |
| Number Of Hispanic Beneficiaries | 322 |
| Number Of American Indian Alaska Native Beneficiaries | 26 |
| Number Of Beneficiaries With Race Not Else where Classified | 48 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1957 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 785 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7408 |