| National Provider Identifier [NPI]: | 1528093663 |
| Last Name Of The Provider | BLOOM |
| First Name Of The Provider | ROY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3400 SPRUCE ST |
| Street Address 2 Of The Provider | 210 WHITE BUILDING |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191044206 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 770 |
| Number Of Medicare Beneficiaries | 354 |
| Total Submitted Charge Amount | 183006 |
| Total Medicare Allowed Amount | 92946.49 |
| Total Medicare Payment Amount | 68988.95 |
| Total Medicare Standardized Payment Amount | 67457.79 |
| 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 | 15 |
| Number Of Medical Services | 770 |
| Number Of Medicare Beneficiaries With Medical Services | 354 |
| Total Medical Submitted Charge Amount | 183006 |
| Total Medical Medicare Allowed Amount | 92946.49 |
| Total Medical Medicare Payment Amount | 68988.95 |
| Total Medical Medicare Standardized Payment Amount | 67457.79 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 190 |
| Number Of Beneficiaries Age 65 to 74 | 135 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 127 |
| Number Of Male Beneficiaries | 227 |
| Number Of Non Hispanic White Beneficiaries | 176 |
| Number Of Black or African American Beneficiaries | 135 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 264 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 90 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 63 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 3.8307 |