| National Provider Identifier [NPI]: | 1538321047 |
| Last Name Of The Provider | BLACKMUN |
| First Name Of The Provider | ANNESSA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4350 N BROADWAY ST |
| Street Address 2 Of The Provider | FLOOR 2 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606131781 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 5897 |
| Number Of Medicare Beneficiaries | 1531 |
| Total Submitted Charge Amount | 216971.25 |
| Total Medicare Allowed Amount | 199084.57 |
| Total Medicare Payment Amount | 141002.01 |
| Total Medicare Standardized Payment Amount | 155334.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 5897 |
| Number Of Medicare Beneficiaries With Medical Services | 1531 |
| Total Medical Submitted Charge Amount | 216971.25 |
| Total Medical Medicare Allowed Amount | 199084.57 |
| Total Medical Medicare Payment Amount | 141002.01 |
| Total Medical Medicare Standardized Payment Amount | 155334.19 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 214 |
| Number Of Beneficiaries Age 65 to 74 | 208 |
| Number Of Beneficiaries Age 75 to 84 | 411 |
| Number Of Beneficiaries Age Greater 84 | 698 |
| Number Of Female Beneficiaries | 1035 |
| Number Of Male Beneficiaries | 496 |
| Number Of Non Hispanic White Beneficiaries | 1387 |
| Number Of Black or African American Beneficiaries | 130 |
| 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 | 474 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1057 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 73 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 53 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 27 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.9209 |