| National Provider Identifier [NPI]: | 1780849562 |
| Last Name Of The Provider | NICHOLS |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1501 S CALIFORNIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606081732 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 189 |
| Number Of Services | 5040 |
| Number Of Medicare Beneficiaries | 3200 |
| Total Submitted Charge Amount | 542482.88 |
| Total Medicare Allowed Amount | 143574.38 |
| Total Medicare Payment Amount | 109443.31 |
| Total Medicare Standardized Payment Amount | 115849.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 342 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 1686.25 |
| Total Drug Medicare AllowedAmount | 308.27 |
| Total Drug Medicare PaymentAmount | 241.7 |
| Total Drug Medicare Standardized Payment Amount | 241.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 186 |
| Number Of Medical Services | 4698 |
| Number Of Medicare Beneficiaries With Medical Services | 3200 |
| Total Medical Submitted Charge Amount | 540796.63 |
| Total Medical Medicare Allowed Amount | 143266.11 |
| Total Medical Medicare Payment Amount | 109201.61 |
| Total Medical Medicare Standardized Payment Amount | 115608.18 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 725 |
| Number Of Beneficiaries Age 65 to 74 | 1099 |
| Number Of Beneficiaries Age 75 to 84 | 912 |
| Number Of Beneficiaries Age Greater 84 | 464 |
| Number Of Female Beneficiaries | 2020 |
| Number Of Male Beneficiaries | 1180 |
| Number Of Non Hispanic White Beneficiaries | 3028 |
| Number Of Black or African American Beneficiaries | 90 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2363 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 837 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4101 |