| National Provider Identifier [NPI]: | 1225004294 |
| Last Name Of The Provider | BORODULIA |
| First Name Of The Provider | NICHOLAS |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1209 COASTAL HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | FENWICK ISLAND |
| Zip Code Of The Provider | 199444401 |
| State Code Of The Provider | DE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 342 |
| Number Of Medicare Beneficiaries | 175 |
| Total Submitted Charge Amount | 54649 |
| Total Medicare Allowed Amount | 31778.42 |
| Total Medicare Payment Amount | 24208.19 |
| Total Medicare Standardized Payment Amount | 24143.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 12 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 300 |
| Total Drug Medicare AllowedAmount | 276.1 |
| Total Drug Medicare PaymentAmount | 270.58 |
| Total Drug Medicare Standardized Payment Amount | 270.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 330 |
| Number Of Medicare Beneficiaries With Medical Services | 175 |
| Total Medical Submitted Charge Amount | 54349 |
| Total Medical Medicare Allowed Amount | 31502.32 |
| Total Medical Medicare Payment Amount | 23937.61 |
| Total Medical Medicare Standardized Payment Amount | 23873.09 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | 54 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 84 |
| Number Of Male Beneficiaries | 91 |
| 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 | 158 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.107 |