| National Provider Identifier [NPI]: | 1073735304 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | MELANIE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 619 19TH ST S |
| Street Address 2 Of The Provider | |
| City Of The Provider | BIRMINGHAM |
| Zip Code Of The Provider | 352490001 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 929 |
| Number Of Medicare Beneficiaries | 224 |
| Total Submitted Charge Amount | 124119.25 |
| Total Medicare Allowed Amount | 58209.01 |
| Total Medicare Payment Amount | 43775.18 |
| Total Medicare Standardized Payment Amount | 47706.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 128 |
| Number Of Medicare Beneficiaries With Drug Services | 90 |
| Total Drug Submitted ChargeAmount | 6727.25 |
| Total Drug Medicare AllowedAmount | 3213.2 |
| Total Drug Medicare PaymentAmount | 3135.18 |
| Total Drug Medicare Standardized Payment Amount | 3135.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 801 |
| Number Of Medicare Beneficiaries With Medical Services | 224 |
| Total Medical Submitted Charge Amount | 117392 |
| Total Medical Medicare Allowed Amount | 54995.81 |
| Total Medical Medicare Payment Amount | 40640 |
| Total Medical Medicare Standardized Payment Amount | 44571.6 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 102 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 139 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | 192 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 177 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.188 |