| National Provider Identifier [NPI]: | 1376533075 |
| Last Name Of The Provider | DEVINE |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1133 COLLEGE AVE |
| Street Address 2 Of The Provider | G100 |
| City Of The Provider | MANHATTAN |
| Zip Code Of The Provider | 665022770 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 97 |
| Number Of Services | 4160 |
| Number Of Medicare Beneficiaries | 1103 |
| Total Submitted Charge Amount | 996094 |
| Total Medicare Allowed Amount | 334991.71 |
| Total Medicare Payment Amount | 247902.19 |
| Total Medicare Standardized Payment Amount | 260595.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 353 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 262468 |
| Total Drug Medicare AllowedAmount | 58942.89 |
| Total Drug Medicare PaymentAmount | 45229.25 |
| Total Drug Medicare Standardized Payment Amount | 45229.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 3807 |
| Number Of Medicare Beneficiaries With Medical Services | 1103 |
| Total Medical Submitted Charge Amount | 733626 |
| Total Medical Medicare Allowed Amount | 276048.82 |
| Total Medical Medicare Payment Amount | 202672.94 |
| Total Medical Medicare Standardized Payment Amount | 215366.37 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 450 |
| Number Of Beneficiaries Age 75 to 84 | 405 |
| Number Of Beneficiaries Age Greater 84 | 197 |
| Number Of Female Beneficiaries | 185 |
| Number Of Male Beneficiaries | 918 |
| Number Of Non Hispanic White Beneficiaries | 1043 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1035 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 30 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0921 |