| National Provider Identifier [NPI]: | 1639126931 |
| Last Name Of The Provider | BLAIR |
| First Name Of The Provider | MICHELE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11970 PRINCE CHARLES CT |
| Street Address 2 Of The Provider | |
| City Of The Provider | CAPE CORAL |
| Zip Code Of The Provider | 339917507 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 96 |
| Number Of Services | 9435 |
| Number Of Medicare Beneficiaries | 2285 |
| Total Submitted Charge Amount | 827554.16 |
| Total Medicare Allowed Amount | 360834.37 |
| Total Medicare Payment Amount | 311393.12 |
| Total Medicare Standardized Payment Amount | 298056.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 5422 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 8923.25 |
| Total Drug Medicare AllowedAmount | 1978.14 |
| Total Drug Medicare PaymentAmount | 1550.8 |
| Total Drug Medicare Standardized Payment Amount | 1550.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 4013 |
| Number Of Medicare Beneficiaries With Medical Services | 2284 |
| Total Medical Submitted Charge Amount | 818630.91 |
| Total Medical Medicare Allowed Amount | 358856.23 |
| Total Medical Medicare Payment Amount | 309842.32 |
| Total Medical Medicare Standardized Payment Amount | 296505.83 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 165 |
| Number Of Beneficiaries Age 65 to 74 | 1213 |
| Number Of Beneficiaries Age 75 to 84 | 741 |
| Number Of Beneficiaries Age Greater 84 | 166 |
| Number Of Female Beneficiaries | 1958 |
| Number Of Male Beneficiaries | 327 |
| Number Of Non Hispanic White Beneficiaries | 2106 |
| Number Of Black or African American Beneficiaries | 42 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 98 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2103 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 182 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0067 |