National Provider Identifier [NPI]: |
1316946957 |
Last Name Of The Provider |
CLARK |
First Name Of The Provider |
JEFFREY |
Middle Initial Of The Provider |
I |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4890 ROSWELL RD NE |
Street Address 2 Of The Provider |
SUITE 250 |
City Of The Provider |
ATLANTA |
Zip Code Of The Provider |
303422606 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
53 |
Number Of Services |
3660 |
Number Of Medicare Beneficiaries |
520 |
Total Submitted Charge Amount |
377598 |
Total Medicare Allowed Amount |
160785.74 |
Total Medicare Payment Amount |
111185.09 |
Total Medicare Standardized Payment Amount |
110966.16 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
242 |
Number Of Medicare Beneficiaries With Drug Services |
176 |
Total Drug Submitted ChargeAmount |
22234 |
Total Drug Medicare AllowedAmount |
7379.98 |
Total Drug Medicare PaymentAmount |
7173.39 |
Total Drug Medicare Standardized Payment Amount |
7173.39 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
46 |
Number Of Medical Services |
3418 |
Number Of Medicare Beneficiaries With Medical Services |
520 |
Total Medical Submitted Charge Amount |
355364 |
Total Medical Medicare Allowed Amount |
153405.76 |
Total Medical Medicare Payment Amount |
104011.7 |
Total Medical Medicare Standardized Payment Amount |
103792.77 |
Average Age Of Beneficiaries |
78 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
183 |
Number Of Beneficiaries Age 75 to 84 |
202 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
274 |
Number Of Male Beneficiaries |
246 |
Number Of Non Hispanic White Beneficiaries |
475 |
Number Of Black or African American Beneficiaries |
30 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
17 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
73 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
26 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
0.9229 |