| National Provider Identifier [NPI]: | 1700874286 |
| Last Name Of The Provider | BLACKHART |
| First Name Of The Provider | BRUCE |
| 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 | 1425 W H ST |
| Street Address 2 Of The Provider | STE 200 |
| City Of The Provider | OAKDALE |
| Zip Code Of The Provider | 953613588 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 875 |
| Number Of Medicare Beneficiaries | 135 |
| Total Submitted Charge Amount | 53643 |
| Total Medicare Allowed Amount | 45032.77 |
| Total Medicare Payment Amount | 33219.86 |
| Total Medicare Standardized Payment Amount | 32578.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 176 |
| Number Of Medicare Beneficiaries With Drug Services | 78 |
| Total Drug Submitted ChargeAmount | 7593 |
| Total Drug Medicare AllowedAmount | 6285.11 |
| Total Drug Medicare PaymentAmount | 6114.05 |
| Total Drug Medicare Standardized Payment Amount | 6114.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 699 |
| Number Of Medicare Beneficiaries With Medical Services | 135 |
| Total Medical Submitted Charge Amount | 46050 |
| Total Medical Medicare Allowed Amount | 38747.66 |
| Total Medical Medicare Payment Amount | 27105.81 |
| Total Medical Medicare Standardized Payment Amount | 26464.93 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 68 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 73 |
| Number Of Male Beneficiaries | 62 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 122 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 8 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 26 |
| Percent Of With Hypertension | 39 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6951 |