| National Provider Identifier [NPI]: | 1619924461 |
| Last Name Of The Provider | BLEZA |
| First Name Of The Provider | MAXIMO |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 825 E LINCOLNWAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | VALPARAISO |
| Zip Code Of The Provider | 463835803 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 199 |
| Number Of Services | 7330 |
| Number Of Medicare Beneficiaries | 4019 |
| Total Submitted Charge Amount | 888714 |
| Total Medicare Allowed Amount | 216574.87 |
| Total Medicare Payment Amount | 161665.2 |
| Total Medicare Standardized Payment Amount | 171156.28 |
| 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 | 199 |
| Number Of Medical Services | 7330 |
| Number Of Medicare Beneficiaries With Medical Services | 4019 |
| Total Medical Submitted Charge Amount | 888714 |
| Total Medical Medicare Allowed Amount | 216574.87 |
| Total Medical Medicare Payment Amount | 161665.2 |
| Total Medical Medicare Standardized Payment Amount | 171156.28 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 679 |
| Number Of Beneficiaries Age 65 to 74 | 1507 |
| Number Of Beneficiaries Age 75 to 84 | 1148 |
| Number Of Beneficiaries Age Greater 84 | 685 |
| Number Of Female Beneficiaries | 2409 |
| Number Of Male Beneficiaries | 1610 |
| Number Of Non Hispanic White Beneficiaries | 3740 |
| Number Of Black or African American Beneficiaries | 97 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 129 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3153 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 866 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6937 |