| National Provider Identifier [NPI]: | 1003846981 |
| Last Name Of The Provider | BLANEY |
| First Name Of The Provider | SAAD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 403 E 1ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | DIXON |
| Zip Code Of The Provider | 610213116 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 820 |
| Number Of Medicare Beneficiaries | 415 |
| Total Submitted Charge Amount | 175037 |
| Total Medicare Allowed Amount | 28897.63 |
| Total Medicare Payment Amount | 22253.42 |
| Total Medicare Standardized Payment Amount | 22949.1 |
| 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 | 15 |
| Number Of Medical Services | 820 |
| Number Of Medicare Beneficiaries With Medical Services | 415 |
| Total Medical Submitted Charge Amount | 175037 |
| Total Medical Medicare Allowed Amount | 28897.63 |
| Total Medical Medicare Payment Amount | 22253.42 |
| Total Medical Medicare Standardized Payment Amount | 22949.1 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 73 |
| Number Of Beneficiaries Age 65 to 74 | 180 |
| Number Of Beneficiaries Age 75 to 84 | 121 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 218 |
| Number Of Male Beneficiaries | 197 |
| Number Of Non Hispanic White Beneficiaries | 391 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 326 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 89 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.2021 |