| National Provider Identifier [NPI]: | 1194981019 |
| Last Name Of The Provider | BLOMGREN |
| First Name Of The Provider | JOSHUA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 25 N WINFIELD ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WINFIELD |
| Zip Code Of The Provider | 601901295 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 2578 |
| Number Of Medicare Beneficiaries | 499 |
| Total Submitted Charge Amount | 552512.03 |
| Total Medicare Allowed Amount | 178838.39 |
| Total Medicare Payment Amount | 135528.88 |
| Total Medicare Standardized Payment Amount | 125541.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 734 |
| Number Of Medicare Beneficiaries With Drug Services | 215 |
| Total Drug Submitted ChargeAmount | 91728 |
| Total Drug Medicare AllowedAmount | 39982.22 |
| Total Drug Medicare PaymentAmount | 31063.94 |
| Total Drug Medicare Standardized Payment Amount | 31063.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 1844 |
| Number Of Medicare Beneficiaries With Medical Services | 499 |
| Total Medical Submitted Charge Amount | 460784.03 |
| Total Medical Medicare Allowed Amount | 138856.17 |
| Total Medical Medicare Payment Amount | 104464.94 |
| Total Medical Medicare Standardized Payment Amount | 94477.14 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 318 |
| Number Of Beneficiaries Age 75 to 84 | 116 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 302 |
| Number Of Male Beneficiaries | 197 |
| Number Of Non Hispanic White Beneficiaries | 412 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 461 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8451 |