| National Provider Identifier [NPI]: | 1487764833 |
| Last Name Of The Provider | BLACKETER |
| First Name Of The Provider | BETHANY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1140 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LIVINGSTON |
| Zip Code Of The Provider | 953341257 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 425 |
| Number Of Medicare Beneficiaries | 206 |
| Total Submitted Charge Amount | 45371.73 |
| Total Medicare Allowed Amount | 24870.41 |
| Total Medicare Payment Amount | 15112.83 |
| Total Medicare Standardized Payment Amount | 14524.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 72 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1215.2 |
| Total Drug Medicare AllowedAmount | 164.84 |
| Total Drug Medicare PaymentAmount | 149.2 |
| Total Drug Medicare Standardized Payment Amount | 149.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 353 |
| Number Of Medicare Beneficiaries With Medical Services | 206 |
| Total Medical Submitted Charge Amount | 44156.53 |
| Total Medical Medicare Allowed Amount | 24705.57 |
| Total Medical Medicare Payment Amount | 14963.63 |
| Total Medical Medicare Standardized Payment Amount | 14374.98 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 69 |
| Number Of Beneficiaries Age 65 to 74 | 76 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 89 |
| Number Of Non Hispanic White Beneficiaries | 63 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 122 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 46 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 160 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 19 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0281 |