| National Provider Identifier [NPI]: | 1588649917 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | RODGER |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5221 US RT 60 E |
| Street Address 2 Of The Provider | RADIOLOGY INC |
| City Of The Provider | HUNTIGTON |
| Zip Code Of The Provider | 25705 |
| State Code Of The Provider | WV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 198 |
| Number Of Services | 13482 |
| Number Of Medicare Beneficiaries | 5128 |
| Total Submitted Charge Amount | 1132986 |
| Total Medicare Allowed Amount | 264249.09 |
| Total Medicare Payment Amount | 197531.52 |
| Total Medicare Standardized Payment Amount | 212792.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 4867 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 2615 |
| Total Drug Medicare AllowedAmount | 893.41 |
| Total Drug Medicare PaymentAmount | 686.99 |
| Total Drug Medicare Standardized Payment Amount | 686.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 196 |
| Number Of Medical Services | 8615 |
| Number Of Medicare Beneficiaries With Medical Services | 5127 |
| Total Medical Submitted Charge Amount | 1130371 |
| Total Medical Medicare Allowed Amount | 263355.68 |
| Total Medical Medicare Payment Amount | 196844.53 |
| Total Medical Medicare Standardized Payment Amount | 212105.43 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 1461 |
| Number Of Beneficiaries Age 65 to 74 | 1894 |
| Number Of Beneficiaries Age 75 to 84 | 1248 |
| Number Of Beneficiaries Age Greater 84 | 525 |
| Number Of Female Beneficiaries | 3109 |
| Number Of Male Beneficiaries | 2019 |
| Number Of Non Hispanic White Beneficiaries | 4963 |
| Number Of Black or African American Beneficiaries | 115 |
| 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 | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3255 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1873 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5765 |