| National Provider Identifier [NPI]: | 1245331685 |
| Last Name Of The Provider | CLINE |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 STUART ST |
| Street Address 2 Of The Provider | MONCRIEF ACH ATTN: MCXL-PQ (CREDENTIALS) |
| City Of The Provider | COLUMBIA |
| Zip Code Of The Provider | 292075700 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 189 |
| Number Of Services | 4386 |
| Number Of Medicare Beneficiaries | 2277 |
| Total Submitted Charge Amount | 491002 |
| Total Medicare Allowed Amount | 132855.32 |
| Total Medicare Payment Amount | 103167.63 |
| Total Medicare Standardized Payment Amount | 106621.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 189 |
| Number Of Medical Services | 4386 |
| Number Of Medicare Beneficiaries With Medical Services | 2277 |
| Total Medical Submitted Charge Amount | 491002 |
| Total Medical Medicare Allowed Amount | 132855.32 |
| Total Medical Medicare Payment Amount | 103167.63 |
| Total Medical Medicare Standardized Payment Amount | 106621.5 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 597 |
| Number Of Beneficiaries Age 65 to 74 | 826 |
| Number Of Beneficiaries Age 75 to 84 | 521 |
| Number Of Beneficiaries Age Greater 84 | 333 |
| Number Of Female Beneficiaries | 1458 |
| Number Of Male Beneficiaries | 819 |
| Number Of Non Hispanic White Beneficiaries | 2162 |
| Number Of Black or African American Beneficiaries | 88 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1630 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 647 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4485 |