| National Provider Identifier [NPI]: | 1821185802 |
| Last Name Of The Provider | BLOHM |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 39339 SPYGLASS PL |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAVIS |
| Zip Code Of The Provider | 956167009 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 90 |
| Number Of Medicare Beneficiaries | 86 |
| Total Submitted Charge Amount | 36324.09 |
| Total Medicare Allowed Amount | 9230.47 |
| Total Medicare Payment Amount | 6253.67 |
| Total Medicare Standardized Payment Amount | 6193.44 |
| 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 | 7 |
| Number Of Medical Services | 90 |
| Number Of Medicare Beneficiaries With Medical Services | 86 |
| Total Medical Submitted Charge Amount | 36324.09 |
| Total Medical Medicare Allowed Amount | 9230.47 |
| Total Medical Medicare Payment Amount | 6253.67 |
| Total Medical Medicare Standardized Payment Amount | 6193.44 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 21 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 41 |
| Number Of Male Beneficiaries | 45 |
| Number Of Non Hispanic White Beneficiaries | 25 |
| Number Of Black or African American Beneficiaries | 25 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 24 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 20 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.3374 |