| National Provider Identifier [NPI]: | 1740249879 |
| Last Name Of The Provider | BLACK |
| First Name Of The Provider | BRANDON |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1619 N GREENWOOD ST |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | PUEBLO |
| Zip Code Of The Provider | 810032644 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 247 |
| Number Of Services | 8040 |
| Number Of Medicare Beneficiaries | 3789 |
| Total Submitted Charge Amount | 2116102 |
| Total Medicare Allowed Amount | 441943.05 |
| Total Medicare Payment Amount | 341345.54 |
| Total Medicare Standardized Payment Amount | 342982.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1335 |
| Number Of Medicare Beneficiaries With Drug Services | 110 |
| Total Drug Submitted ChargeAmount | 12505 |
| Total Drug Medicare AllowedAmount | 1140.84 |
| Total Drug Medicare PaymentAmount | 894.17 |
| Total Drug Medicare Standardized Payment Amount | 894.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 244 |
| Number Of Medical Services | 6705 |
| Number Of Medicare Beneficiaries With Medical Services | 3789 |
| Total Medical Submitted Charge Amount | 2103597 |
| Total Medical Medicare Allowed Amount | 440802.21 |
| Total Medical Medicare Payment Amount | 340451.37 |
| Total Medical Medicare Standardized Payment Amount | 342087.86 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 826 |
| Number Of Beneficiaries Age 65 to 74 | 1433 |
| Number Of Beneficiaries Age 75 to 84 | 1040 |
| Number Of Beneficiaries Age Greater 84 | 490 |
| Number Of Female Beneficiaries | 2313 |
| Number Of Male Beneficiaries | 1476 |
| Number Of Non Hispanic White Beneficiaries | 2761 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 932 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2729 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1060 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4827 |