| National Provider Identifier [NPI]: | 1174674436 |
| Last Name Of The Provider | SURDOCK |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 47 PENNY LN |
| Street Address 2 Of The Provider | SUITE 1 |
| City Of The Provider | WATSONVILLE |
| Zip Code Of The Provider | 950766055 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 5243 |
| Number Of Medicare Beneficiaries | 971 |
| Total Submitted Charge Amount | 406349.12 |
| Total Medicare Allowed Amount | 293679.5 |
| Total Medicare Payment Amount | 216068.77 |
| Total Medicare Standardized Payment Amount | 209391.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 186 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 13434.12 |
| Total Drug Medicare AllowedAmount | 12894.18 |
| Total Drug Medicare PaymentAmount | 10085.08 |
| Total Drug Medicare Standardized Payment Amount | 10085.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 5057 |
| Number Of Medicare Beneficiaries With Medical Services | 971 |
| Total Medical Submitted Charge Amount | 392915 |
| Total Medical Medicare Allowed Amount | 280785.32 |
| Total Medical Medicare Payment Amount | 205983.69 |
| Total Medical Medicare Standardized Payment Amount | 199306.2 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 168 |
| Number Of Beneficiaries Age 65 to 74 | 266 |
| Number Of Beneficiaries Age 75 to 84 | 262 |
| Number Of Beneficiaries Age Greater 84 | 275 |
| Number Of Female Beneficiaries | 569 |
| Number Of Male Beneficiaries | 402 |
| Number Of Non Hispanic White Beneficiaries | 526 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 403 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 567 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 404 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.7461 |