| National Provider Identifier [NPI]: | 1629054705 |
| Last Name Of The Provider | BLACKWELL |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9700 EL CAMINO REAL |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | ATASCADERO |
| Zip Code Of The Provider | 93422 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 779 |
| Number Of Medicare Beneficiaries | 423 |
| Total Submitted Charge Amount | 97418 |
| Total Medicare Allowed Amount | 55821.82 |
| Total Medicare Payment Amount | 33467.36 |
| Total Medicare Standardized Payment Amount | 40597.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 65 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 1795 |
| Total Drug Medicare AllowedAmount | 505.85 |
| Total Drug Medicare PaymentAmount | 386.65 |
| Total Drug Medicare Standardized Payment Amount | 386.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 714 |
| Number Of Medicare Beneficiaries With Medical Services | 423 |
| Total Medical Submitted Charge Amount | 95623 |
| Total Medical Medicare Allowed Amount | 55315.97 |
| Total Medical Medicare Payment Amount | 33080.71 |
| Total Medical Medicare Standardized Payment Amount | 40210.89 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 221 |
| Number Of Beneficiaries Age 75 to 84 | 115 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 260 |
| Number Of Male Beneficiaries | 163 |
| Number Of Non Hispanic White Beneficiaries | 399 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 386 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.867 |