| National Provider Identifier [NPI]: | 1518252477 |
| Last Name Of The Provider | NURSE |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2700 GRANT ST |
| Street Address 2 Of The Provider | #200 |
| City Of The Provider | CONCORD |
| Zip Code Of The Provider | 945202266 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 104 |
| Number Of Medicare Beneficiaries | 40 |
| Total Submitted Charge Amount | 13599 |
| Total Medicare Allowed Amount | 7501.47 |
| Total Medicare Payment Amount | 5834.36 |
| Total Medicare Standardized Payment Amount | 5170.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 14 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 401 |
| Total Drug Medicare AllowedAmount | 179.62 |
| Total Drug Medicare PaymentAmount | 175.55 |
| Total Drug Medicare Standardized Payment Amount | 175.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 90 |
| Number Of Medicare Beneficiaries With Medical Services | 40 |
| Total Medical Submitted Charge Amount | 13198 |
| Total Medical Medicare Allowed Amount | 7321.85 |
| Total Medical Medicare Payment Amount | 5658.81 |
| Total Medical Medicare Standardized Payment Amount | 4994.46 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 28 |
| Number Of Male Beneficiaries | 12 |
| 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 | 24 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 16 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.371 |