| National Provider Identifier [NPI]: | 1134162795 |
| Last Name Of The Provider | BLACKWOOD |
| First Name Of The Provider | GLENN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1701 N SENATE BLVD |
| Street Address 2 Of The Provider | ROOM 1204A |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462021239 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 3247 |
| Number Of Medicare Beneficiaries | 2356 |
| Total Submitted Charge Amount | 221029 |
| Total Medicare Allowed Amount | 75414.59 |
| Total Medicare Payment Amount | 56097.51 |
| Total Medicare Standardized Payment Amount | 59076.97 |
| 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 | 83 |
| Number Of Medical Services | 3247 |
| Number Of Medicare Beneficiaries With Medical Services | 2356 |
| Total Medical Submitted Charge Amount | 221029 |
| Total Medical Medicare Allowed Amount | 75414.59 |
| Total Medical Medicare Payment Amount | 56097.51 |
| Total Medical Medicare Standardized Payment Amount | 59076.97 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 816 |
| Number Of Beneficiaries Age 65 to 74 | 684 |
| Number Of Beneficiaries Age 75 to 84 | 537 |
| Number Of Beneficiaries Age Greater 84 | 319 |
| Number Of Female Beneficiaries | 1375 |
| Number Of Male Beneficiaries | 981 |
| Number Of Non Hispanic White Beneficiaries | 1781 |
| Number Of Black or African American Beneficiaries | 510 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1319 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1037 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.4511 |