| National Provider Identifier [NPI]: | 1508000332 |
| Last Name Of The Provider | PRINE |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3200 RIVERSIDE DR |
| Street Address 2 Of The Provider | BLDG C |
| City Of The Provider | MACON |
| Zip Code Of The Provider | 312102550 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 2325 |
| Number Of Medicare Beneficiaries | 698 |
| Total Submitted Charge Amount | 736815 |
| Total Medicare Allowed Amount | 160906.18 |
| Total Medicare Payment Amount | 132959.4 |
| Total Medicare Standardized Payment Amount | 137490.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 40 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 1820 |
| Total Drug Medicare AllowedAmount | 219.33 |
| Total Drug Medicare PaymentAmount | 171.34 |
| Total Drug Medicare Standardized Payment Amount | 171.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 2285 |
| Number Of Medicare Beneficiaries With Medical Services | 697 |
| Total Medical Submitted Charge Amount | 734995 |
| Total Medical Medicare Allowed Amount | 160686.85 |
| Total Medical Medicare Payment Amount | 132788.06 |
| Total Medical Medicare Standardized Payment Amount | 137319.01 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 314 |
| Number Of Beneficiaries Age 65 to 74 | 244 |
| Number Of Beneficiaries Age 75 to 84 | 110 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 445 |
| Number Of Male Beneficiaries | 253 |
| Number Of Non Hispanic White Beneficiaries | 513 |
| Number Of Black or African American Beneficiaries | 163 |
| 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 | 520 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 178 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3807 |