| National Provider Identifier [NPI]: | 1689698946 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | SUZZANE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4188 NW LOOP |
| Street Address 2 Of The Provider | |
| City Of The Provider | CARTHAGE |
| Zip Code Of The Provider | 756332255 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 1816 |
| Number Of Medicare Beneficiaries | 252 |
| Total Submitted Charge Amount | 174450.47 |
| Total Medicare Allowed Amount | 69809.87 |
| Total Medicare Payment Amount | 46178.96 |
| Total Medicare Standardized Payment Amount | 49011.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 286 |
| Number Of Medicare Beneficiaries With Drug Services | 97 |
| Total Drug Submitted ChargeAmount | 4710.01 |
| Total Drug Medicare AllowedAmount | 1187.27 |
| Total Drug Medicare PaymentAmount | 1007.63 |
| Total Drug Medicare Standardized Payment Amount | 1007.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 1530 |
| Number Of Medicare Beneficiaries With Medical Services | 252 |
| Total Medical Submitted Charge Amount | 169740.46 |
| Total Medical Medicare Allowed Amount | 68622.6 |
| Total Medical Medicare Payment Amount | 45171.33 |
| Total Medical Medicare Standardized Payment Amount | 48003.43 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 118 |
| Number Of Beneficiaries Age 75 to 84 | 77 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 161 |
| Number Of Male Beneficiaries | 91 |
| Number Of Non Hispanic White Beneficiaries | 208 |
| 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 | 218 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 0.8691 |