| National Provider Identifier [NPI]: | 1619059516 |
| Last Name Of The Provider | BLODGETT |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 39 HIDDEN VALLEY DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BIDWELL |
| Zip Code Of The Provider | 456149591 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 10450 |
| Number Of Medicare Beneficiaries | 1521 |
| Total Submitted Charge Amount | 1009202 |
| Total Medicare Allowed Amount | 616000.71 |
| Total Medicare Payment Amount | 439734.21 |
| Total Medicare Standardized Payment Amount | 456313.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 157 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 13356 |
| Total Drug Medicare AllowedAmount | 10777.07 |
| Total Drug Medicare PaymentAmount | 8273.16 |
| Total Drug Medicare Standardized Payment Amount | 8273.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 10293 |
| Number Of Medicare Beneficiaries With Medical Services | 1521 |
| Total Medical Submitted Charge Amount | 995846 |
| Total Medical Medicare Allowed Amount | 605223.64 |
| Total Medical Medicare Payment Amount | 431461.05 |
| Total Medical Medicare Standardized Payment Amount | 448040.1 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 110 |
| Number Of Beneficiaries Age 65 to 74 | 621 |
| Number Of Beneficiaries Age 75 to 84 | 588 |
| Number Of Beneficiaries Age Greater 84 | 202 |
| Number Of Female Beneficiaries | 766 |
| Number Of Male Beneficiaries | 755 |
| Number Of Non Hispanic White Beneficiaries | 1496 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| 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 | 1342 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 179 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0249 |