| National Provider Identifier [NPI]: | 1538194261 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | TERESA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2045 PEACHTREE RD NE |
| Street Address 2 Of The Provider | SUITE 400 |
| City Of The Provider | ATLANTA |
| Zip Code Of The Provider | 303091432 |
| 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 | 46 |
| Number Of Services | 4202 |
| Number Of Medicare Beneficiaries | 840 |
| Total Submitted Charge Amount | 629094 |
| Total Medicare Allowed Amount | 275730.58 |
| Total Medicare Payment Amount | 213719.71 |
| Total Medicare Standardized Payment Amount | 213185.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 272 |
| Number Of Medicare Beneficiaries With Drug Services | 230 |
| Total Drug Submitted ChargeAmount | 35856 |
| Total Drug Medicare AllowedAmount | 12264.78 |
| Total Drug Medicare PaymentAmount | 12017.3 |
| Total Drug Medicare Standardized Payment Amount | 12017.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 3930 |
| Number Of Medicare Beneficiaries With Medical Services | 840 |
| Total Medical Submitted Charge Amount | 593238 |
| Total Medical Medicare Allowed Amount | 263465.8 |
| Total Medical Medicare Payment Amount | 201702.41 |
| Total Medical Medicare Standardized Payment Amount | 201168.43 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 351 |
| Number Of Beneficiaries Age 75 to 84 | 259 |
| Number Of Beneficiaries Age Greater 84 | 182 |
| Number Of Female Beneficiaries | 608 |
| Number Of Male Beneficiaries | 232 |
| Number Of Non Hispanic White Beneficiaries | 579 |
| Number Of Black or African American Beneficiaries | 221 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 674 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 166 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.338 |