| National Provider Identifier [NPI]: | 1801854898 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | DONNEVAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 744 S WEBSTER AVE FL 2 |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREEN BAY |
| Zip Code Of The Provider | 543013505 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 2831 |
| Number Of Medicare Beneficiaries | 1542 |
| Total Submitted Charge Amount | 988303 |
| Total Medicare Allowed Amount | 145221.23 |
| Total Medicare Payment Amount | 109971.38 |
| Total Medicare Standardized Payment Amount | 113375.11 |
| 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 | 53 |
| Number Of Medical Services | 2831 |
| Number Of Medicare Beneficiaries With Medical Services | 1542 |
| Total Medical Submitted Charge Amount | 988303 |
| Total Medical Medicare Allowed Amount | 145221.23 |
| Total Medical Medicare Payment Amount | 109971.38 |
| Total Medical Medicare Standardized Payment Amount | 113375.11 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 167 |
| Number Of Beneficiaries Age 65 to 74 | 573 |
| Number Of Beneficiaries Age 75 to 84 | 516 |
| Number Of Beneficiaries Age Greater 84 | 286 |
| Number Of Female Beneficiaries | 789 |
| Number Of Male Beneficiaries | 753 |
| Number Of Non Hispanic White Beneficiaries | 1484 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 22 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1286 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 256 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.3388 |