| National Provider Identifier [NPI]: | 1235224718 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | STEVEN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3625 UNIVERSITY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 32216 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 908 |
| Number Of Medicare Beneficiaries | 721 |
| Total Submitted Charge Amount | 1177252 |
| Total Medicare Allowed Amount | 143050.79 |
| Total Medicare Payment Amount | 111217.79 |
| Total Medicare Standardized Payment Amount | 109353.23 |
| 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 | 19 |
| Number Of Medical Services | 908 |
| Number Of Medicare Beneficiaries With Medical Services | 721 |
| Total Medical Submitted Charge Amount | 1177252 |
| Total Medical Medicare Allowed Amount | 143050.79 |
| Total Medical Medicare Payment Amount | 111217.79 |
| Total Medical Medicare Standardized Payment Amount | 109353.23 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 214 |
| Number Of Beneficiaries Age 65 to 74 | 204 |
| Number Of Beneficiaries Age 75 to 84 | 179 |
| Number Of Beneficiaries Age Greater 84 | 124 |
| Number Of Female Beneficiaries | 426 |
| Number Of Male Beneficiaries | 295 |
| Number Of Non Hispanic White Beneficiaries | 456 |
| Number Of Black or African American Beneficiaries | 198 |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 368 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 353 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 19 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.6827 |