| National Provider Identifier [NPI]: | 1215058110 |
| Last Name Of The Provider | BLACKMON |
| First Name Of The Provider | BILLY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2041 GLENNFIELD LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUGUSTA |
| Zip Code Of The Provider | 309090205 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 247 |
| Number Of Services | 10728 |
| Number Of Medicare Beneficiaries | 5323 |
| Total Submitted Charge Amount | 1455414 |
| Total Medicare Allowed Amount | 322062.08 |
| Total Medicare Payment Amount | 245075.88 |
| Total Medicare Standardized Payment Amount | 255851.92 |
| 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 | 247 |
| Number Of Medical Services | 10728 |
| Number Of Medicare Beneficiaries With Medical Services | 5323 |
| Total Medical Submitted Charge Amount | 1455414 |
| Total Medical Medicare Allowed Amount | 322062.08 |
| Total Medical Medicare Payment Amount | 245075.88 |
| Total Medical Medicare Standardized Payment Amount | 255851.92 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1136 |
| Number Of Beneficiaries Age 65 to 74 | 2156 |
| Number Of Beneficiaries Age 75 to 84 | 1398 |
| Number Of Beneficiaries Age Greater 84 | 633 |
| Number Of Female Beneficiaries | 3301 |
| Number Of Male Beneficiaries | 2022 |
| Number Of Non Hispanic White Beneficiaries | 4265 |
| Number Of Black or African American Beneficiaries | 924 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 64 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3894 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1429 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5503 |