| National Provider Identifier [NPI]: | 1992708655 |
| Last Name Of The Provider | BLACKHART |
| First Name Of The Provider | BRET |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 640 W MOANA LN |
| Street Address 2 Of The Provider | STE 2 |
| City Of The Provider | RENO |
| Zip Code Of The Provider | 895094857 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 6870 |
| Number Of Medicare Beneficiaries | 2329 |
| Total Submitted Charge Amount | 663075.77 |
| Total Medicare Allowed Amount | 480888.86 |
| Total Medicare Payment Amount | 345254.73 |
| Total Medicare Standardized Payment Amount | 300265.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 223 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 709.46 |
| Total Drug Medicare AllowedAmount | 398.36 |
| Total Drug Medicare PaymentAmount | 234.13 |
| Total Drug Medicare Standardized Payment Amount | 234.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 6647 |
| Number Of Medicare Beneficiaries With Medical Services | 2329 |
| Total Medical Submitted Charge Amount | 662366.31 |
| Total Medical Medicare Allowed Amount | 480490.5 |
| Total Medical Medicare Payment Amount | 345020.6 |
| Total Medical Medicare Standardized Payment Amount | 300031.43 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 69 |
| Number Of Beneficiaries Age 65 to 74 | 1184 |
| Number Of Beneficiaries Age 75 to 84 | 769 |
| Number Of Beneficiaries Age Greater 84 | 307 |
| Number Of Female Beneficiaries | 1022 |
| Number Of Male Beneficiaries | 1307 |
| Number Of Non Hispanic White Beneficiaries | 2227 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 43 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2280 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8518 |