| National Provider Identifier [NPI]: | 1730199290 |
| Last Name Of The Provider | BLACK |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 401 BAPTIST DR |
| Street Address 2 Of The Provider | SUITE 104 |
| City Of The Provider | MADISON |
| Zip Code Of The Provider | 391102009 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 2481 |
| Number Of Medicare Beneficiaries | 331 |
| Total Submitted Charge Amount | 153939.69 |
| Total Medicare Allowed Amount | 81304 |
| Total Medicare Payment Amount | 58800.95 |
| Total Medicare Standardized Payment Amount | 64816.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 297 |
| Number Of Medicare Beneficiaries With Drug Services | 123 |
| Total Drug Submitted ChargeAmount | 7704.19 |
| Total Drug Medicare AllowedAmount | 1883.72 |
| Total Drug Medicare PaymentAmount | 1635.3 |
| Total Drug Medicare Standardized Payment Amount | 1635.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 2184 |
| Number Of Medicare Beneficiaries With Medical Services | 330 |
| Total Medical Submitted Charge Amount | 146235.5 |
| Total Medical Medicare Allowed Amount | 79420.28 |
| Total Medical Medicare Payment Amount | 57165.65 |
| Total Medical Medicare Standardized Payment Amount | 63181.05 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 178 |
| Number Of Beneficiaries Age 75 to 84 | 86 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 176 |
| Number Of Male Beneficiaries | 155 |
| Number Of Non Hispanic White Beneficiaries | 300 |
| 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 | 310 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 45 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7987 |