| National Provider Identifier [NPI]: | 1326353350 |
| Last Name Of The Provider | BLACKMORE |
| First Name Of The Provider | AMANDA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1100 N SAINT FRANCIS ST |
| Street Address 2 Of The Provider | STE 130 |
| City Of The Provider | WICHITA |
| Zip Code Of The Provider | 672142878 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 442 |
| Number Of Medicare Beneficiaries | 271 |
| Total Submitted Charge Amount | 44307 |
| Total Medicare Allowed Amount | 26304.35 |
| Total Medicare Payment Amount | 20467.06 |
| Total Medicare Standardized Payment Amount | 25107.68 |
| 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 | 7 |
| Number Of Medical Services | 442 |
| Number Of Medicare Beneficiaries With Medical Services | 271 |
| Total Medical Submitted Charge Amount | 44307 |
| Total Medical Medicare Allowed Amount | 26304.35 |
| Total Medical Medicare Payment Amount | 20467.06 |
| Total Medical Medicare Standardized Payment Amount | 25107.68 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 97 |
| Number Of Beneficiaries Age 65 to 74 | 76 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 130 |
| Number Of Male Beneficiaries | 141 |
| Number Of Non Hispanic White Beneficiaries | 230 |
| Number Of Black or African American Beneficiaries | 18 |
| 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 | 181 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 90 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 56 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 62 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 3.499 |