| National Provider Identifier [NPI]: | 1831167451 |
| Last Name Of The Provider | BLACKWELL |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1818 121ST ST SE |
| Street Address 2 Of The Provider | |
| City Of The Provider | EVERETT |
| Zip Code Of The Provider | 982085985 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 1075 |
| Number Of Medicare Beneficiaries | 84 |
| Total Submitted Charge Amount | 70560.25 |
| Total Medicare Allowed Amount | 31242.5 |
| Total Medicare Payment Amount | 23242.67 |
| Total Medicare Standardized Payment Amount | 24009.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 226 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 1210.75 |
| Total Drug Medicare AllowedAmount | 512.44 |
| Total Drug Medicare PaymentAmount | 368.46 |
| Total Drug Medicare Standardized Payment Amount | 368.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 87 |
| Number Of Medical Services | 849 |
| Number Of Medicare Beneficiaries With Medical Services | 84 |
| Total Medical Submitted Charge Amount | 69349.5 |
| Total Medical Medicare Allowed Amount | 30730.06 |
| Total Medical Medicare Payment Amount | 22874.21 |
| Total Medical Medicare Standardized Payment Amount | 23641.52 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 40 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 35 |
| Number Of Male Beneficiaries | 49 |
| Number Of Non Hispanic White Beneficiaries | 69 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 73 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| 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 | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9912 |