| National Provider Identifier [NPI]: | 1376506642 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 535 NW 9TH ST |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731021070 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Otolaryngology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 1899 |
| Number Of Medicare Beneficiaries | 472 |
| Total Submitted Charge Amount | 549010.66 |
| Total Medicare Allowed Amount | 215981.54 |
| Total Medicare Payment Amount | 160418.26 |
| Total Medicare Standardized Payment Amount | 169166.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 599 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 8200.31 |
| Total Drug Medicare AllowedAmount | 3296.53 |
| Total Drug Medicare PaymentAmount | 2584.22 |
| Total Drug Medicare Standardized Payment Amount | 2584.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 86 |
| Number Of Medical Services | 1300 |
| Number Of Medicare Beneficiaries With Medical Services | 472 |
| Total Medical Submitted Charge Amount | 540810.35 |
| Total Medical Medicare Allowed Amount | 212685.01 |
| Total Medical Medicare Payment Amount | 157834.04 |
| Total Medical Medicare Standardized Payment Amount | 166582.31 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | 231 |
| Number Of Beneficiaries Age 75 to 84 | 119 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 288 |
| Number Of Male Beneficiaries | 184 |
| Number Of Non Hispanic White Beneficiaries | 381 |
| Number Of Black or African American Beneficiaries | 46 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 21 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 386 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 86 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2572 |