| National Provider Identifier [NPI]: | 1235153735 |
| Last Name Of The Provider | BLACKMON |
| First Name Of The Provider | GARYUN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1640 E ROSEVILLE PKWY |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | ROSEVILLE |
| Zip Code Of The Provider | 956613902 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 116 |
| Number Of Services | 6720 |
| Number Of Medicare Beneficiaries | 852 |
| Total Submitted Charge Amount | 710199.38 |
| Total Medicare Allowed Amount | 134757.57 |
| Total Medicare Payment Amount | 102277.61 |
| Total Medicare Standardized Payment Amount | 96986.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 5563 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 11845 |
| Total Drug Medicare AllowedAmount | 1861.46 |
| Total Drug Medicare PaymentAmount | 1459.41 |
| Total Drug Medicare Standardized Payment Amount | 1459.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 1157 |
| Number Of Medicare Beneficiaries With Medical Services | 849 |
| Total Medical Submitted Charge Amount | 698354.38 |
| Total Medical Medicare Allowed Amount | 132896.11 |
| Total Medical Medicare Payment Amount | 100818.2 |
| Total Medical Medicare Standardized Payment Amount | 95526.93 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 402 |
| Number Of Beneficiaries Age 75 to 84 | 256 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 543 |
| Number Of Male Beneficiaries | 309 |
| Number Of Non Hispanic White Beneficiaries | 697 |
| Number Of Black or African American Beneficiaries | 31 |
| Number Of AsianPacific Islander Beneficiaries | 42 |
| Number Of Hispanic Beneficiaries | 61 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 703 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 149 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1579 |