| National Provider Identifier [NPI]: | 1689620650 |
| Last Name Of The Provider | MALCOM |
| First Name Of The Provider | CLINT |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MH APRN |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2315 W 39TH ST |
| Street Address 2 Of The Provider | UNIT #6 |
| City Of The Provider | KEARNEY |
| Zip Code Of The Provider | 688458327 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 549 |
| Number Of Medicare Beneficiaries | 154 |
| Total Submitted Charge Amount | 72791 |
| Total Medicare Allowed Amount | 34879.43 |
| Total Medicare Payment Amount | 23885.11 |
| Total Medicare Standardized Payment Amount | 31223.1 |
| 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 | 4 |
| Number Of Medical Services | 549 |
| Number Of Medicare Beneficiaries With Medical Services | 154 |
| Total Medical Submitted Charge Amount | 72791 |
| Total Medical Medicare Allowed Amount | 34879.43 |
| Total Medical Medicare Payment Amount | 23885.11 |
| Total Medical Medicare Standardized Payment Amount | 31223.1 |
| Average Age Of Beneficiaries | 53 |
| Number Of Beneficiaries Age Less65 | 111 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 93 |
| Number Of Male Beneficiaries | 61 |
| 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 | 36 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 118 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 67 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 29 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0529 |