| National Provider Identifier [NPI]: | 1437112703 |
| Last Name Of The Provider | HINES |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 451 NORTH DUNLAP STREET |
| Street Address 2 Of The Provider | MAIL STOP 32700A |
| City Of The Provider | ST PAUL |
| Zip Code Of The Provider | 551044621 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 1513 |
| Number Of Medicare Beneficiaries | 208 |
| Total Submitted Charge Amount | 141326 |
| Total Medicare Allowed Amount | 53132.09 |
| Total Medicare Payment Amount | 37020.28 |
| Total Medicare Standardized Payment Amount | 37893.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 589 |
| Number Of Medicare Beneficiaries With Drug Services | 70 |
| Total Drug Submitted ChargeAmount | 7625 |
| Total Drug Medicare AllowedAmount | 4102.34 |
| Total Drug Medicare PaymentAmount | 3424.19 |
| Total Drug Medicare Standardized Payment Amount | 3424.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 924 |
| Number Of Medicare Beneficiaries With Medical Services | 207 |
| Total Medical Submitted Charge Amount | 133701 |
| Total Medical Medicare Allowed Amount | 49029.75 |
| Total Medical Medicare Payment Amount | 33596.09 |
| Total Medical Medicare Standardized Payment Amount | 34468.99 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 144 |
| Number Of Beneficiaries Age 65 to 74 | 48 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 104 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 80 |
| Number Of Black or African American Beneficiaries | 99 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| 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 | 46 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 162 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 18 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4178 |