| National Provider Identifier [NPI]: | 1225066939 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | RODERICK |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2804 AMBASSADOR CAFFERY PKWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 705065906 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 2405 |
| Number Of Medicare Beneficiaries | 613 |
| Total Submitted Charge Amount | 513082 |
| Total Medicare Allowed Amount | 178316.52 |
| Total Medicare Payment Amount | 137379.21 |
| Total Medicare Standardized Payment Amount | 143534.79 |
| 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 | 27 |
| Number Of Medical Services | 2405 |
| Number Of Medicare Beneficiaries With Medical Services | 613 |
| Total Medical Submitted Charge Amount | 513082 |
| Total Medical Medicare Allowed Amount | 178316.52 |
| Total Medical Medicare Payment Amount | 137379.21 |
| Total Medical Medicare Standardized Payment Amount | 143534.79 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 173 |
| Number Of Beneficiaries Age 65 to 74 | 188 |
| Number Of Beneficiaries Age 75 to 84 | 177 |
| Number Of Beneficiaries Age Greater 84 | 75 |
| Number Of Female Beneficiaries | 305 |
| Number Of Male Beneficiaries | 308 |
| Number Of Non Hispanic White Beneficiaries | 376 |
| Number Of Black or African American Beneficiaries | 213 |
| 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 | 362 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 251 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 64 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 64 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 71 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 4.1998 |