| National Provider Identifier [NPI]: | 1023040334 |
| Last Name Of The Provider | BLACKMAN |
| First Name Of The Provider | JACQUES |
| 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 | 13213 W 21ST ST N |
| Street Address 2 Of The Provider | |
| City Of The Provider | WICHITA |
| Zip Code Of The Provider | 672359625 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 1885 |
| Number Of Medicare Beneficiaries | 490 |
| Total Submitted Charge Amount | 140596 |
| Total Medicare Allowed Amount | 95115.11 |
| Total Medicare Payment Amount | 61463.96 |
| Total Medicare Standardized Payment Amount | 66964.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 463 |
| Number Of Medicare Beneficiaries With Drug Services | 216 |
| Total Drug Submitted ChargeAmount | 13207 |
| Total Drug Medicare AllowedAmount | 6873.4 |
| Total Drug Medicare PaymentAmount | 6175.82 |
| Total Drug Medicare Standardized Payment Amount | 6175.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 1422 |
| Number Of Medicare Beneficiaries With Medical Services | 490 |
| Total Medical Submitted Charge Amount | 127389 |
| Total Medical Medicare Allowed Amount | 88241.71 |
| Total Medical Medicare Payment Amount | 55288.14 |
| Total Medical Medicare Standardized Payment Amount | 60789.15 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 253 |
| Number Of Beneficiaries Age 75 to 84 | 136 |
| Number Of Beneficiaries Age Greater 84 | 57 |
| Number Of Female Beneficiaries | 225 |
| Number Of Male Beneficiaries | 265 |
| Number Of Non Hispanic White Beneficiaries | 476 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 465 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8865 |