| National Provider Identifier [NPI]: | 1518946540 |
| Last Name Of The Provider | DEVINE |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6909 PROSPERITY CHURCH RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HUNTERSVILLE |
| Zip Code Of The Provider | 280786698 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 2701 |
| Number Of Medicare Beneficiaries | 270 |
| Total Submitted Charge Amount | 314727 |
| Total Medicare Allowed Amount | 140418.59 |
| Total Medicare Payment Amount | 99151.71 |
| Total Medicare Standardized Payment Amount | 103705.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 540 |
| Number Of Medicare Beneficiaries With Drug Services | 143 |
| Total Drug Submitted ChargeAmount | 24555 |
| Total Drug Medicare AllowedAmount | 7030.1 |
| Total Drug Medicare PaymentAmount | 6007.64 |
| Total Drug Medicare Standardized Payment Amount | 6007.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 88 |
| Number Of Medical Services | 2161 |
| Number Of Medicare Beneficiaries With Medical Services | 269 |
| Total Medical Submitted Charge Amount | 290172 |
| Total Medical Medicare Allowed Amount | 133388.49 |
| Total Medical Medicare Payment Amount | 93144.07 |
| Total Medical Medicare Standardized Payment Amount | 97698.34 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 133 |
| Number Of Beneficiaries Age 75 to 84 | 78 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 155 |
| Number Of Male Beneficiaries | 115 |
| Number Of Non Hispanic White Beneficiaries | 197 |
| Number Of Black or African American Beneficiaries | 53 |
| 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 | 238 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1609 |