| National Provider Identifier [NPI]: | 1922031657 |
| Last Name Of The Provider | HINE |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 331 VERANDA ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 041035545 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 1096 |
| Number Of Medicare Beneficiaries | 158 |
| Total Submitted Charge Amount | 76639.5 |
| Total Medicare Allowed Amount | 42912.33 |
| Total Medicare Payment Amount | 35734.33 |
| Total Medicare Standardized Payment Amount | 35838.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 1474.5 |
| Total Drug Medicare AllowedAmount | 1165.44 |
| Total Drug Medicare PaymentAmount | 1142.14 |
| Total Drug Medicare Standardized Payment Amount | 1142.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 1068 |
| Number Of Medicare Beneficiaries With Medical Services | 158 |
| Total Medical Submitted Charge Amount | 75165 |
| Total Medical Medicare Allowed Amount | 41746.89 |
| Total Medical Medicare Payment Amount | 34592.19 |
| Total Medical Medicare Standardized Payment Amount | 34695.99 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | 143 |
| 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 | 90 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 38 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 18 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9309 |