| National Provider Identifier [NPI]: | 1841227535 |
| Last Name Of The Provider | BLUE |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 365 MONTAUK AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW LONDON |
| Zip Code Of The Provider | 06320 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 200 |
| Number Of Services | 3896 |
| Number Of Medicare Beneficiaries | 2455 |
| Total Submitted Charge Amount | 629153 |
| Total Medicare Allowed Amount | 153441.35 |
| Total Medicare Payment Amount | 117331.94 |
| Total Medicare Standardized Payment Amount | 112083.22 |
| 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 | 200 |
| Number Of Medical Services | 3896 |
| Number Of Medicare Beneficiaries With Medical Services | 2455 |
| Total Medical Submitted Charge Amount | 629153 |
| Total Medical Medicare Allowed Amount | 153441.35 |
| Total Medical Medicare Payment Amount | 117331.94 |
| Total Medical Medicare Standardized Payment Amount | 112083.22 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 389 |
| Number Of Beneficiaries Age 65 to 74 | 900 |
| Number Of Beneficiaries Age 75 to 84 | 719 |
| Number Of Beneficiaries Age Greater 84 | 447 |
| Number Of Female Beneficiaries | 1592 |
| Number Of Male Beneficiaries | 863 |
| Number Of Non Hispanic White Beneficiaries | 2124 |
| Number Of Black or African American Beneficiaries | 127 |
| Number Of AsianPacific Islander Beneficiaries | 35 |
| Number Of Hispanic Beneficiaries | 109 |
| Number Of American Indian Alaska Native Beneficiaries | 12 |
| Number Of Beneficiaries With Race Not Else where Classified | 48 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1738 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 717 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5574 |