| National Provider Identifier [NPI]: | 1568628139 |
| Last Name Of The Provider | NIBLACK |
| First Name Of The Provider | CRANE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D.,M.S |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5001 E PATRICK HENRY HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | BURKEVILLE |
| Zip Code Of The Provider | 239223460 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 118 |
| Number Of Medicare Beneficiaries | 56 |
| Total Submitted Charge Amount | 10678.89 |
| Total Medicare Allowed Amount | 9192.97 |
| Total Medicare Payment Amount | 7211.4 |
| Total Medicare Standardized Payment Amount | 7317.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 11 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 264 |
| Total Drug Medicare AllowedAmount | 197.78 |
| Total Drug Medicare PaymentAmount | 193.82 |
| Total Drug Medicare Standardized Payment Amount | 193.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 107 |
| Number Of Medicare Beneficiaries With Medical Services | 53 |
| Total Medical Submitted Charge Amount | 10414.89 |
| Total Medical Medicare Allowed Amount | 8995.19 |
| Total Medical Medicare Payment Amount | 7017.58 |
| Total Medical Medicare Standardized Payment Amount | 7123.99 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 38 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 27 |
| Number Of Male Beneficiaries | 29 |
| Number Of Non Hispanic White Beneficiaries | 36 |
| 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 | 32 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 71 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 70 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4339 |