| National Provider Identifier [NPI]: | 1447355789 |
| Last Name Of The Provider | BISTLINE |
| First Name Of The Provider | JANE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2047 PALM BEACH LAKES BLVD |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | WEST PALM BEACH |
| Zip Code Of The Provider | 334096500 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 1829 |
| Number Of Medicare Beneficiaries | 205 |
| Total Submitted Charge Amount | 725695.2 |
| Total Medicare Allowed Amount | 175204.03 |
| Total Medicare Payment Amount | 130982.54 |
| Total Medicare Standardized Payment Amount | 127053.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 230 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 3450 |
| Total Drug Medicare AllowedAmount | 1303.68 |
| Total Drug Medicare PaymentAmount | 1019.2 |
| Total Drug Medicare Standardized Payment Amount | 1019.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 1599 |
| Number Of Medicare Beneficiaries With Medical Services | 205 |
| Total Medical Submitted Charge Amount | 722245.2 |
| Total Medical Medicare Allowed Amount | 173900.35 |
| Total Medical Medicare Payment Amount | 129963.34 |
| Total Medical Medicare Standardized Payment Amount | 126034.62 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 81 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 135 |
| Number Of Male Beneficiaries | 70 |
| Number Of Non Hispanic White Beneficiaries | 167 |
| Number Of Black or African American Beneficiaries | 25 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 143 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5095 |