| National Provider Identifier [NPI]: | 1396782488 |
| Last Name Of The Provider | BLALOCK |
| First Name Of The Provider | CLYDE |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 955 RIBAUT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEAUFORT |
| Zip Code Of The Provider | 299025441 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 233 |
| Number Of Services | 10836 |
| Number Of Medicare Beneficiaries | 4815 |
| Total Submitted Charge Amount | 1488555.5 |
| Total Medicare Allowed Amount | 312994.05 |
| Total Medicare Payment Amount | 240441.14 |
| Total Medicare Standardized Payment Amount | 253465 |
| 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 | 233 |
| Number Of Medical Services | 10836 |
| Number Of Medicare Beneficiaries With Medical Services | 4815 |
| Total Medical Submitted Charge Amount | 1488555.5 |
| Total Medical Medicare Allowed Amount | 312994.05 |
| Total Medical Medicare Payment Amount | 240441.14 |
| Total Medical Medicare Standardized Payment Amount | 253465 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 626 |
| Number Of Beneficiaries Age 65 to 74 | 2293 |
| Number Of Beneficiaries Age 75 to 84 | 1370 |
| Number Of Beneficiaries Age Greater 84 | 526 |
| Number Of Female Beneficiaries | 3106 |
| Number Of Male Beneficiaries | 1709 |
| Number Of Non Hispanic White Beneficiaries | 3525 |
| Number Of Black or African American Beneficiaries | 1151 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 56 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 59 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4142 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 673 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.251 |