| National Provider Identifier [NPI]: | 1225205230 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD, MPH |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LEWISTON |
| Zip Code Of The Provider | 042407027 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 523 |
| Number Of Medicare Beneficiaries | 468 |
| Total Submitted Charge Amount | 173761.6 |
| Total Medicare Allowed Amount | 54286.53 |
| Total Medicare Payment Amount | 39926.53 |
| Total Medicare Standardized Payment Amount | 41552.21 |
| 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 | 21 |
| Number Of Medical Services | 523 |
| Number Of Medicare Beneficiaries With Medical Services | 468 |
| Total Medical Submitted Charge Amount | 173761.6 |
| Total Medical Medicare Allowed Amount | 54286.53 |
| Total Medical Medicare Payment Amount | 39926.53 |
| Total Medical Medicare Standardized Payment Amount | 41552.21 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 151 |
| Number Of Beneficiaries Age 65 to 74 | 106 |
| Number Of Beneficiaries Age 75 to 84 | 126 |
| Number Of Beneficiaries Age Greater 84 | 85 |
| Number Of Female Beneficiaries | 282 |
| Number Of Male Beneficiaries | 186 |
| Number Of Non Hispanic White Beneficiaries | 457 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 199 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 269 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6834 |