| National Provider Identifier [NPI]: | 1013186964 |
| Last Name Of The Provider | BLACK |
| First Name Of The Provider | CHAD |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 E 8TH ST |
| Street Address 2 Of The Provider | POST OFFICE BOX 2280 |
| City Of The Provider | ANNISTON |
| Zip Code Of The Provider | 362075754 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 121 |
| Number Of Services | 3858.5 |
| Number Of Medicare Beneficiaries | 548 |
| Total Submitted Charge Amount | 582175.03 |
| Total Medicare Allowed Amount | 355834.34 |
| Total Medicare Payment Amount | 264475.5 |
| Total Medicare Standardized Payment Amount | 268836.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 218.5 |
| Number Of Medicare Beneficiaries With Drug Services | 64 |
| Total Drug Submitted ChargeAmount | 5964 |
| Total Drug Medicare AllowedAmount | 1627.75 |
| Total Drug Medicare PaymentAmount | 1327.67 |
| Total Drug Medicare Standardized Payment Amount | 1327.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 3640 |
| Number Of Medicare Beneficiaries With Medical Services | 546 |
| Total Medical Submitted Charge Amount | 576211.03 |
| Total Medical Medicare Allowed Amount | 354206.59 |
| Total Medical Medicare Payment Amount | 263147.83 |
| Total Medical Medicare Standardized Payment Amount | 267508.37 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 260 |
| Number Of Beneficiaries Age 75 to 84 | 131 |
| Number Of Beneficiaries Age Greater 84 | 97 |
| Number Of Female Beneficiaries | 316 |
| Number Of Male Beneficiaries | 232 |
| Number Of Non Hispanic White Beneficiaries | 448 |
| Number Of Black or African American Beneficiaries | 41 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 40 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 443 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 105 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.4767 |