| National Provider Identifier [NPI]: | 1356583611 |
| Last Name Of The Provider | BLANKENSHIP |
| First Name Of The Provider | JAY |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | UNIVERSITY OF UTAH DIV OF EMERGENCY MEDICINE |
| Street Address 2 Of The Provider | 30 NORTH 1900 EAST RM 1C026 |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 841320001 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 1021 |
| Number Of Medicare Beneficiaries | 667 |
| Total Submitted Charge Amount | 314087 |
| Total Medicare Allowed Amount | 106997.31 |
| Total Medicare Payment Amount | 81387.44 |
| Total Medicare Standardized Payment Amount | 84954.9 |
| 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 | 32 |
| Number Of Medical Services | 1021 |
| Number Of Medicare Beneficiaries With Medical Services | 667 |
| Total Medical Submitted Charge Amount | 314087 |
| Total Medical Medicare Allowed Amount | 106997.31 |
| Total Medical Medicare Payment Amount | 81387.44 |
| Total Medical Medicare Standardized Payment Amount | 84954.9 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 183 |
| Number Of Beneficiaries Age 65 to 74 | 193 |
| Number Of Beneficiaries Age 75 to 84 | 182 |
| Number Of Beneficiaries Age Greater 84 | 109 |
| Number Of Female Beneficiaries | 400 |
| Number Of Male Beneficiaries | 267 |
| Number Of Non Hispanic White Beneficiaries | 535 |
| Number Of Black or African American Beneficiaries | 120 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 423 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 244 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.155 |