| National Provider Identifier [NPI]: | 1457443368 |
| Last Name Of The Provider | BLAINE |
| First Name Of The Provider | DENNIS |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3104 SUNSET BLVD #2B |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROCKLIN |
| Zip Code Of The Provider | 95677 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 333 |
| Number Of Medicare Beneficiaries | 263 |
| Total Submitted Charge Amount | 106753 |
| Total Medicare Allowed Amount | 25413.97 |
| Total Medicare Payment Amount | 18571.24 |
| Total Medicare Standardized Payment Amount | 21869.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 333 |
| Number Of Medicare Beneficiaries With Medical Services | 263 |
| Total Medical Submitted Charge Amount | 106753 |
| Total Medical Medicare Allowed Amount | 25413.97 |
| Total Medical Medicare Payment Amount | 18571.24 |
| Total Medical Medicare Standardized Payment Amount | 21869.56 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 103 |
| Number Of Non Hispanic White Beneficiaries | 87 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | 59 |
| 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 | 82 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 181 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.541 |