| National Provider Identifier [NPI]: | 1013908607 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12951 SOUTH FWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770471923 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 156 |
| Number Of Services | 20309 |
| Number Of Medicare Beneficiaries | 2240 |
| Total Submitted Charge Amount | 1677640 |
| Total Medicare Allowed Amount | 416975.44 |
| Total Medicare Payment Amount | 332528.02 |
| Total Medicare Standardized Payment Amount | 322100.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 16732 |
| Number Of Medicare Beneficiaries With Drug Services | 214 |
| Total Drug Submitted ChargeAmount | 24948 |
| Total Drug Medicare AllowedAmount | 5220.52 |
| Total Drug Medicare PaymentAmount | 4054.37 |
| Total Drug Medicare Standardized Payment Amount | 4054.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 154 |
| Number Of Medical Services | 3577 |
| Number Of Medicare Beneficiaries With Medical Services | 2236 |
| Total Medical Submitted Charge Amount | 1652692 |
| Total Medical Medicare Allowed Amount | 411754.92 |
| Total Medical Medicare Payment Amount | 328473.65 |
| Total Medical Medicare Standardized Payment Amount | 318045.88 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 221 |
| Number Of Beneficiaries Age 65 to 74 | 1057 |
| Number Of Beneficiaries Age 75 to 84 | 640 |
| Number Of Beneficiaries Age Greater 84 | 322 |
| Number Of Female Beneficiaries | 1542 |
| Number Of Male Beneficiaries | 698 |
| Number Of Non Hispanic White Beneficiaries | 1961 |
| Number Of Black or African American Beneficiaries | 115 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 110 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1948 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 292 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2387 |