National Provider Identifier [NPI]: |
1205893757 |
Last Name Of The Provider |
KLINE |
First Name Of The Provider |
MARTIN |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2131 N RIDGE RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
WICHITA |
Zip Code Of The Provider |
672121570 |
State Code Of The Provider |
KS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
73 |
Number Of Services |
1334 |
Number Of Medicare Beneficiaries |
261 |
Total Submitted Charge Amount |
87421 |
Total Medicare Allowed Amount |
42085.33 |
Total Medicare Payment Amount |
28135.1 |
Total Medicare Standardized Payment Amount |
36037.31 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
16 |
Number Of Drug Services |
416 |
Number Of Medicare Beneficiaries With Drug Services |
87 |
Total Drug Submitted ChargeAmount |
8265 |
Total Drug Medicare AllowedAmount |
1841.56 |
Total Drug Medicare PaymentAmount |
1471.34 |
Total Drug Medicare Standardized Payment Amount |
1471.34 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
57 |
Number Of Medical Services |
918 |
Number Of Medicare Beneficiaries With Medical Services |
261 |
Total Medical Submitted Charge Amount |
79156 |
Total Medical Medicare Allowed Amount |
40243.77 |
Total Medical Medicare Payment Amount |
26663.76 |
Total Medical Medicare Standardized Payment Amount |
34565.97 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
31 |
Number Of Beneficiaries Age 65 to 74 |
112 |
Number Of Beneficiaries Age 75 to 84 |
79 |
Number Of Beneficiaries Age Greater 84 |
39 |
Number Of Female Beneficiaries |
147 |
Number Of Male Beneficiaries |
114 |
Number Of Non Hispanic White Beneficiaries |
211 |
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 |
214 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
47 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
|
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
22 |
Percent Of With Depression |
17 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
36 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
0.9389 |