| National Provider Identifier [NPI]: | 1316972458 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | PHILMORE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 188 ABNER JACKSON PKWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE JACKSON |
| Zip Code Of The Provider | 775665160 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 2412 |
| Number Of Medicare Beneficiaries | 591 |
| Total Submitted Charge Amount | 765703.28 |
| Total Medicare Allowed Amount | 260394.21 |
| Total Medicare Payment Amount | 196317.61 |
| Total Medicare Standardized Payment Amount | 195359.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 58 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 16682.81 |
| Total Drug Medicare AllowedAmount | 7025.16 |
| Total Drug Medicare PaymentAmount | 5449.87 |
| Total Drug Medicare Standardized Payment Amount | 5449.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 2354 |
| Number Of Medicare Beneficiaries With Medical Services | 591 |
| Total Medical Submitted Charge Amount | 749020.47 |
| Total Medical Medicare Allowed Amount | 253369.05 |
| Total Medical Medicare Payment Amount | 190867.74 |
| Total Medical Medicare Standardized Payment Amount | 189909.52 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 231 |
| Number Of Beneficiaries Age 75 to 84 | 216 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 109 |
| Number Of Male Beneficiaries | 482 |
| Number Of Non Hispanic White Beneficiaries | 456 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 507 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 84 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2244 |