| National Provider Identifier [NPI]: | 1558340844 |
| Last Name Of The Provider | BLAINE |
| First Name Of The Provider | CLINTON |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3295 POPLAR AVE STE 105 |
| Street Address 2 Of The Provider | |
| City Of The Provider | MEMPHIS |
| Zip Code Of The Provider | 381114690 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 1829 |
| Number Of Medicare Beneficiaries | 331 |
| Total Submitted Charge Amount | 84306 |
| Total Medicare Allowed Amount | 47438.03 |
| Total Medicare Payment Amount | 32224.49 |
| Total Medicare Standardized Payment Amount | 41711.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 1190 |
| Number Of Medicare Beneficiaries With Drug Services | 176 |
| Total Drug Submitted ChargeAmount | 12766 |
| Total Drug Medicare AllowedAmount | 1250.83 |
| Total Drug Medicare PaymentAmount | 998.06 |
| Total Drug Medicare Standardized Payment Amount | 998.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 639 |
| Number Of Medicare Beneficiaries With Medical Services | 330 |
| Total Medical Submitted Charge Amount | 71540 |
| Total Medical Medicare Allowed Amount | 46187.2 |
| Total Medical Medicare Payment Amount | 31226.43 |
| Total Medical Medicare Standardized Payment Amount | 40713.8 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 152 |
| Number Of Beneficiaries Age 75 to 84 | 87 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 195 |
| Number Of Male Beneficiaries | 136 |
| Number Of Non Hispanic White Beneficiaries | 301 |
| 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 | 250 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 81 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0758 |