| National Provider Identifier [NPI]: | 1831170208 |
| Last Name Of The Provider | BLACKWELL |
| First Name Of The Provider | JOHN |
| 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 | 1203 24TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MERIDIAN |
| Zip Code Of The Provider | 393013926 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 294 |
| Number Of Services | 9935 |
| Number Of Medicare Beneficiaries | 4917 |
| Total Submitted Charge Amount | 1613413 |
| Total Medicare Allowed Amount | 305305.17 |
| Total Medicare Payment Amount | 230258.47 |
| Total Medicare Standardized Payment Amount | 242726.86 |
| 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 | 294 |
| Number Of Medical Services | 9935 |
| Number Of Medicare Beneficiaries With Medical Services | 4917 |
| Total Medical Submitted Charge Amount | 1613413 |
| Total Medical Medicare Allowed Amount | 305305.17 |
| Total Medical Medicare Payment Amount | 230258.47 |
| Total Medical Medicare Standardized Payment Amount | 242726.86 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 989 |
| Number Of Beneficiaries Age 65 to 74 | 1705 |
| Number Of Beneficiaries Age 75 to 84 | 1504 |
| Number Of Beneficiaries Age Greater 84 | 719 |
| Number Of Female Beneficiaries | 2920 |
| Number Of Male Beneficiaries | 1997 |
| Number Of Non Hispanic White Beneficiaries | 3532 |
| Number Of Black or African American Beneficiaries | 1263 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 85 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3296 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1621 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5991 |