National Provider Identifier [NPI]: |
1629023890 |
Last Name Of The Provider |
CLINE |
First Name Of The Provider |
ELIJAH |
Middle Initial Of The Provider |
G |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
923 E CENTRAL AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
LA FOLLETTE |
Zip Code Of The Provider |
377662768 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
24 |
Number Of Services |
568 |
Number Of Medicare Beneficiaries |
350 |
Total Submitted Charge Amount |
374234 |
Total Medicare Allowed Amount |
58695.12 |
Total Medicare Payment Amount |
44094.97 |
Total Medicare Standardized Payment Amount |
46582.17 |
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 |
24 |
Number Of Medical Services |
568 |
Number Of Medicare Beneficiaries With Medical Services |
350 |
Total Medical Submitted Charge Amount |
374234 |
Total Medical Medicare Allowed Amount |
58695.12 |
Total Medical Medicare Payment Amount |
44094.97 |
Total Medical Medicare Standardized Payment Amount |
46582.17 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
134 |
Number Of Beneficiaries Age 65 to 74 |
98 |
Number Of Beneficiaries Age 75 to 84 |
79 |
Number Of Beneficiaries Age Greater 84 |
39 |
Number Of Female Beneficiaries |
194 |
Number Of Male Beneficiaries |
156 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
132 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
218 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
36 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
47 |
Percent Of With Depression |
39 |
Percent Of With Diabetes |
45 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
51 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.5834 |