| National Provider Identifier [NPI]: | 1316930118 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | BRYAN |
| 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 | 939 THORNTON RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LITHIA SPRINGS |
| Zip Code Of The Provider | 301222634 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 1047 |
| Number Of Medicare Beneficiaries | 165 |
| Total Submitted Charge Amount | 99598 |
| Total Medicare Allowed Amount | 47113.73 |
| Total Medicare Payment Amount | 33939.55 |
| Total Medicare Standardized Payment Amount | 33883.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 78 |
| Total Drug Medicare AllowedAmount | 27.38 |
| Total Drug Medicare PaymentAmount | 12.72 |
| Total Drug Medicare Standardized Payment Amount | 12.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 1034 |
| Number Of Medicare Beneficiaries With Medical Services | 165 |
| Total Medical Submitted Charge Amount | 99520 |
| Total Medical Medicare Allowed Amount | 47086.35 |
| Total Medical Medicare Payment Amount | 33926.83 |
| Total Medical Medicare Standardized Payment Amount | 33870.83 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 81 |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 89 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 93 |
| 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 | 76 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 89 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3369 |