| National Provider Identifier [NPI]: | 1255425831 |
| Last Name Of The Provider | BLAKE |
| First Name Of The Provider | CYNTHEA |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | M.D., PH.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3010 N. CIRCLE DRIVE SUITE 120 |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLORADO SPRINGS |
| Zip Code Of The Provider | 80209 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 6439 |
| Number Of Medicare Beneficiaries | 94 |
| Total Submitted Charge Amount | 92106.61 |
| Total Medicare Allowed Amount | 55218.1 |
| Total Medicare Payment Amount | 40255.11 |
| Total Medicare Standardized Payment Amount | 41719.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 6248 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 45338.61 |
| Total Drug Medicare AllowedAmount | 34524.93 |
| Total Drug Medicare PaymentAmount | 27001.29 |
| Total Drug Medicare Standardized Payment Amount | 27001.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 191 |
| Number Of Medicare Beneficiaries With Medical Services | 94 |
| Total Medical Submitted Charge Amount | 46768 |
| Total Medical Medicare Allowed Amount | 20693.17 |
| Total Medical Medicare Payment Amount | 13253.82 |
| Total Medical Medicare Standardized Payment Amount | 14718.69 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 73 |
| Number Of Male Beneficiaries | 21 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 70 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.3291 |