| National Provider Identifier [NPI]: | 1669443503 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | TOSHALENE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5314 NW 64TH STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | KANSAS CITY |
| Zip Code Of The Provider | 64151 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 260 |
| Number Of Medicare Beneficiaries | 136 |
| Total Submitted Charge Amount | 10234.2 |
| Total Medicare Allowed Amount | 7964.01 |
| Total Medicare Payment Amount | 6016.09 |
| Total Medicare Standardized Payment Amount | 7617.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 82 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 2629.2 |
| Total Drug Medicare AllowedAmount | 2199 |
| Total Drug Medicare PaymentAmount | 2154.92 |
| Total Drug Medicare Standardized Payment Amount | 2154.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 178 |
| Number Of Medicare Beneficiaries With Medical Services | 135 |
| Total Medical Submitted Charge Amount | 7605 |
| Total Medical Medicare Allowed Amount | 5765.01 |
| Total Medical Medicare Payment Amount | 3861.17 |
| Total Medical Medicare Standardized Payment Amount | 5462.32 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 90 |
| Number Of Male Beneficiaries | 46 |
| Number Of Non Hispanic White Beneficiaries | 125 |
| Number Of Black or African American Beneficiaries | |
| 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 | 120 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 16 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6791 |