| National Provider Identifier [NPI]: | 1427000751 |
| Last Name Of The Provider | DAVIS |
| First Name Of The Provider | CLIFFORD |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 805 SUNSET BLVD |
| Street Address 2 Of The Provider | P O 758 |
| City Of The Provider | CONRAD |
| Zip Code Of The Provider | 594251717 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 359 |
| Number Of Medicare Beneficiaries | 172 |
| Total Submitted Charge Amount | 36143.98 |
| Total Medicare Allowed Amount | 18762.59 |
| Total Medicare Payment Amount | 12346.1 |
| Total Medicare Standardized Payment Amount | 15040.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 56 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 658.59 |
| Total Drug Medicare AllowedAmount | 347.77 |
| Total Drug Medicare PaymentAmount | 320.64 |
| Total Drug Medicare Standardized Payment Amount | 320.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 303 |
| Number Of Medicare Beneficiaries With Medical Services | 172 |
| Total Medical Submitted Charge Amount | 35485.39 |
| Total Medical Medicare Allowed Amount | 18414.82 |
| Total Medical Medicare Payment Amount | 12025.46 |
| Total Medical Medicare Standardized Payment Amount | 14720.17 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 96 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 155 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 31 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7822 |