| National Provider Identifier [NPI]: | 1134165285 |
| Last Name Of The Provider | BLANCO |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 FOXCROFT AVE |
| Street Address 2 Of The Provider | SUITE 202B |
| City Of The Provider | MARTINSBURG |
| Zip Code Of The Provider | 254015341 |
| State Code Of The Provider | WV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 225 |
| Number Of Services | 6682 |
| Number Of Medicare Beneficiaries | 3315 |
| Total Submitted Charge Amount | 577979 |
| Total Medicare Allowed Amount | 227456.09 |
| Total Medicare Payment Amount | 162928.91 |
| Total Medicare Standardized Payment Amount | 171430.38 |
| 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 | 225 |
| Number Of Medical Services | 6682 |
| Number Of Medicare Beneficiaries With Medical Services | 3315 |
| Total Medical Submitted Charge Amount | 577979 |
| Total Medical Medicare Allowed Amount | 227456.09 |
| Total Medical Medicare Payment Amount | 162928.91 |
| Total Medical Medicare Standardized Payment Amount | 171430.38 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 797 |
| Number Of Beneficiaries Age 65 to 74 | 1350 |
| Number Of Beneficiaries Age 75 to 84 | 809 |
| Number Of Beneficiaries Age Greater 84 | 359 |
| Number Of Female Beneficiaries | 2180 |
| Number Of Male Beneficiaries | 1135 |
| Number Of Non Hispanic White Beneficiaries | 3031 |
| Number Of Black or African American Beneficiaries | 205 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2315 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1000 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4612 |