| National Provider Identifier [NPI]: | 1235127861 |
| Last Name Of The Provider | BLANCO |
| First Name Of The Provider | MIGUEL |
| 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 | 951 ROANOKE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | RIVERHEAD |
| Zip Code Of The Provider | 119012724 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 5438 |
| Number Of Medicare Beneficiaries | 1779 |
| Total Submitted Charge Amount | 1361400 |
| Total Medicare Allowed Amount | 589891.05 |
| Total Medicare Payment Amount | 442731.96 |
| Total Medicare Standardized Payment Amount | 391694.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 572 |
| Number Of Medicare Beneficiaries With Drug Services | 145 |
| Total Drug Submitted ChargeAmount | 64902 |
| Total Drug Medicare AllowedAmount | 27269.18 |
| Total Drug Medicare PaymentAmount | 20950.57 |
| Total Drug Medicare Standardized Payment Amount | 20950.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 4866 |
| Number Of Medicare Beneficiaries With Medical Services | 1778 |
| Total Medical Submitted Charge Amount | 1296498 |
| Total Medical Medicare Allowed Amount | 562621.87 |
| Total Medical Medicare Payment Amount | 421781.39 |
| Total Medical Medicare Standardized Payment Amount | 370744.09 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 632 |
| Number Of Beneficiaries Age 75 to 84 | 663 |
| Number Of Beneficiaries Age Greater 84 | 385 |
| Number Of Female Beneficiaries | 845 |
| Number Of Male Beneficiaries | 934 |
| Number Of Non Hispanic White Beneficiaries | 1595 |
| Number Of Black or African American Beneficiaries | 81 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 58 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1590 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 189 |
| Percent Of With Atrial Fibrillation | 38 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 72 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6324 |