| National Provider Identifier [NPI]: | 1982638466 |
| Last Name Of The Provider | SHELINE |
| First Name Of The Provider | MARTIN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 527 N. PALO ALTO AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PANAMA CITY |
| Zip Code Of The Provider | 324013639 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 309 |
| Number Of Services | 8558 |
| Number Of Medicare Beneficiaries | 4383 |
| Total Submitted Charge Amount | 2022969.2 |
| Total Medicare Allowed Amount | 692050.26 |
| Total Medicare Payment Amount | 537745.61 |
| Total Medicare Standardized Payment Amount | 543114.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 263 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 1619.2 |
| Total Drug Medicare AllowedAmount | 194.38 |
| Total Drug Medicare PaymentAmount | 152.26 |
| Total Drug Medicare Standardized Payment Amount | 152.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 298 |
| Number Of Medical Services | 8295 |
| Number Of Medicare Beneficiaries With Medical Services | 4383 |
| Total Medical Submitted Charge Amount | 2021350 |
| Total Medical Medicare Allowed Amount | 691855.88 |
| Total Medical Medicare Payment Amount | 537593.35 |
| Total Medical Medicare Standardized Payment Amount | 542962.54 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 953 |
| Number Of Beneficiaries Age 65 to 74 | 1488 |
| Number Of Beneficiaries Age 75 to 84 | 1315 |
| Number Of Beneficiaries Age Greater 84 | 627 |
| Number Of Female Beneficiaries | 2444 |
| Number Of Male Beneficiaries | 1939 |
| Number Of Non Hispanic White Beneficiaries | 3818 |
| Number Of Black or African American Beneficiaries | 426 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 56 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 44 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3089 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1294 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8548 |