| National Provider Identifier [NPI]: | 1154324945 |
| Last Name Of The Provider | KING |
| First Name Of The Provider | STANLEY |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 205 HOSPITAL DR |
| Street Address 2 Of The Provider | STE A |
| City Of The Provider | MC KENZIE |
| Zip Code Of The Provider | 382011649 |
| 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 | 88 |
| Number Of Services | 1846 |
| Number Of Medicare Beneficiaries | 384 |
| Total Submitted Charge Amount | 92354 |
| Total Medicare Allowed Amount | 41771.87 |
| Total Medicare Payment Amount | 31433.37 |
| Total Medicare Standardized Payment Amount | 37594.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 275 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 3613 |
| Total Drug Medicare AllowedAmount | 375.56 |
| Total Drug Medicare PaymentAmount | 262.49 |
| Total Drug Medicare Standardized Payment Amount | 262.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 1571 |
| Number Of Medicare Beneficiaries With Medical Services | 384 |
| Total Medical Submitted Charge Amount | 88741 |
| Total Medical Medicare Allowed Amount | 41396.31 |
| Total Medical Medicare Payment Amount | 31170.88 |
| Total Medical Medicare Standardized Payment Amount | 37331.64 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 106 |
| Number Of Beneficiaries Age 65 to 74 | 132 |
| Number Of Beneficiaries Age 75 to 84 | 80 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | 217 |
| Number Of Male Beneficiaries | 167 |
| Number Of Non Hispanic White Beneficiaries | 339 |
| 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 | 164 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 220 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 32 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 18 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.7455 |