| National Provider Identifier [NPI]: | 1548298433 |
| Last Name Of The Provider | BEANBLOSSOM |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6420 DUTCHMANS PKWY |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402053372 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 8049 |
| Number Of Medicare Beneficiaries | 2700 |
| Total Submitted Charge Amount | 668448 |
| Total Medicare Allowed Amount | 311912.45 |
| Total Medicare Payment Amount | 228295.78 |
| Total Medicare Standardized Payment Amount | 245788.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 8049 |
| Number Of Medicare Beneficiaries With Medical Services | 2700 |
| Total Medical Submitted Charge Amount | 668448 |
| Total Medical Medicare Allowed Amount | 311912.45 |
| Total Medical Medicare Payment Amount | 228295.78 |
| Total Medical Medicare Standardized Payment Amount | 245788.23 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 508 |
| Number Of Beneficiaries Age 65 to 74 | 883 |
| Number Of Beneficiaries Age 75 to 84 | 820 |
| Number Of Beneficiaries Age Greater 84 | 489 |
| Number Of Female Beneficiaries | 1439 |
| Number Of Male Beneficiaries | 1261 |
| Number Of Non Hispanic White Beneficiaries | 2396 |
| Number Of Black or African American Beneficiaries | 253 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2110 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 590 |
| Percent Of With Atrial Fibrillation | 35 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 69 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.8687 |