| National Provider Identifier [NPI]: | 1164487146 |
| Last Name Of The Provider | HENDERSON |
| First Name Of The Provider | REINO |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10301 KANIS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 722056205 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 2495 |
| Number Of Medicare Beneficiaries | 695 |
| Total Submitted Charge Amount | 352913.28 |
| Total Medicare Allowed Amount | 169179.04 |
| Total Medicare Payment Amount | 128043.7 |
| Total Medicare Standardized Payment Amount | 143024.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 771 |
| Number Of Medicare Beneficiaries With Drug Services | 278 |
| Total Drug Submitted ChargeAmount | 146603.28 |
| Total Drug Medicare AllowedAmount | 88722.54 |
| Total Drug Medicare PaymentAmount | 69417.2 |
| Total Drug Medicare Standardized Payment Amount | 69417.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1724 |
| Number Of Medicare Beneficiaries With Medical Services | 695 |
| Total Medical Submitted Charge Amount | 206310 |
| Total Medical Medicare Allowed Amount | 80456.5 |
| Total Medical Medicare Payment Amount | 58626.5 |
| Total Medical Medicare Standardized Payment Amount | 73607.72 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 395 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 421 |
| Number Of Male Beneficiaries | 274 |
| Number Of Non Hispanic White Beneficiaries | 650 |
| 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 | 649 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8683 |