| National Provider Identifier [NPI]: | 1801899281 |
| Last Name Of The Provider | LAVINE |
| First Name Of The Provider | MARC |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3998 RED LION RD |
| Street Address 2 Of The Provider | STE 305 |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191141436 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 2270 |
| Number Of Medicare Beneficiaries | 739 |
| Total Submitted Charge Amount | 798122 |
| Total Medicare Allowed Amount | 185848.66 |
| Total Medicare Payment Amount | 141389.08 |
| Total Medicare Standardized Payment Amount | 134092.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 54 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 63710 |
| Total Drug Medicare AllowedAmount | 10263.46 |
| Total Drug Medicare PaymentAmount | 8018.69 |
| Total Drug Medicare Standardized Payment Amount | 8018.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 2216 |
| Number Of Medicare Beneficiaries With Medical Services | 739 |
| Total Medical Submitted Charge Amount | 734412 |
| Total Medical Medicare Allowed Amount | 175585.2 |
| Total Medical Medicare Payment Amount | 133370.39 |
| Total Medical Medicare Standardized Payment Amount | 126073.99 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 162 |
| Number Of Beneficiaries Age 65 to 74 | 316 |
| Number Of Beneficiaries Age 75 to 84 | 158 |
| Number Of Beneficiaries Age Greater 84 | 103 |
| Number Of Female Beneficiaries | 205 |
| Number Of Male Beneficiaries | 534 |
| Number Of Non Hispanic White Beneficiaries | 629 |
| Number Of Black or African American Beneficiaries | 48 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 514 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 225 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.754 |