| National Provider Identifier [NPI]: | 1386870772 |
| Last Name Of The Provider | PHILLIPS |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1001 W 10TH ST |
| Street Address 2 Of The Provider | WEST BUILDING M200 |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462022859 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 939 |
| Number Of Medicare Beneficiaries | 165 |
| Total Submitted Charge Amount | 115574 |
| Total Medicare Allowed Amount | 53294.2 |
| Total Medicare Payment Amount | 37769.9 |
| Total Medicare Standardized Payment Amount | 41329.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 62 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 3647 |
| Total Drug Medicare AllowedAmount | 2389.63 |
| Total Drug Medicare PaymentAmount | 2341.04 |
| Total Drug Medicare Standardized Payment Amount | 2341.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 877 |
| Number Of Medicare Beneficiaries With Medical Services | 165 |
| Total Medical Submitted Charge Amount | 111927 |
| Total Medical Medicare Allowed Amount | 50904.57 |
| Total Medical Medicare Payment Amount | 35428.86 |
| Total Medical Medicare Standardized Payment Amount | 38988.92 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 127 |
| Number Of Male Beneficiaries | 38 |
| Number Of Non Hispanic White Beneficiaries | 145 |
| 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 | 103 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2644 |