| National Provider Identifier [NPI]: | 1497753552 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | LETITIA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3800 RESERVOIR RD NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | WASHINGTON |
| Zip Code Of The Provider | 200072113 |
| State Code Of The Provider | DC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 93 |
| Number Of Services | 2967 |
| Number Of Medicare Beneficiaries | 1809 |
| Total Submitted Charge Amount | 645052 |
| Total Medicare Allowed Amount | 254271.59 |
| Total Medicare Payment Amount | 193113.09 |
| Total Medicare Standardized Payment Amount | 165373.42 |
| 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 | 93 |
| Number Of Medical Services | 2967 |
| Number Of Medicare Beneficiaries With Medical Services | 1809 |
| Total Medical Submitted Charge Amount | 645052 |
| Total Medical Medicare Allowed Amount | 254271.59 |
| Total Medical Medicare Payment Amount | 193113.09 |
| Total Medical Medicare Standardized Payment Amount | 165373.42 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 108 |
| Number Of Beneficiaries Age 65 to 74 | 802 |
| Number Of Beneficiaries Age 75 to 84 | 611 |
| Number Of Beneficiaries Age Greater 84 | 288 |
| Number Of Female Beneficiaries | 1099 |
| Number Of Male Beneficiaries | 710 |
| Number Of Non Hispanic White Beneficiaries | 1410 |
| Number Of Black or African American Beneficiaries | 243 |
| Number Of AsianPacific Islander Beneficiaries | 42 |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 67 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1664 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 145 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3208 |