| National Provider Identifier [NPI]: | 1396772828 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10215 KINGSTON PIKE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | KNOXVILLE |
| Zip Code Of The Provider | 379223222 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 6115 |
| Number Of Medicare Beneficiaries | 288 |
| Total Submitted Charge Amount | 343218.5 |
| Total Medicare Allowed Amount | 177544.17 |
| Total Medicare Payment Amount | 136440.33 |
| Total Medicare Standardized Payment Amount | 145347.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 916 |
| Number Of Medicare Beneficiaries With Drug Services | 143 |
| Total Drug Submitted ChargeAmount | 19287.5 |
| Total Drug Medicare AllowedAmount | 12712.45 |
| Total Drug Medicare PaymentAmount | 10560.92 |
| Total Drug Medicare Standardized Payment Amount | 10560.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 113 |
| Number Of Medical Services | 5199 |
| Number Of Medicare Beneficiaries With Medical Services | 288 |
| Total Medical Submitted Charge Amount | 323931 |
| Total Medical Medicare Allowed Amount | 164831.72 |
| Total Medical Medicare Payment Amount | 125879.41 |
| Total Medical Medicare Standardized Payment Amount | 134786.95 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 144 |
| Number Of Beneficiaries Age 75 to 84 | 84 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 138 |
| Number Of Male Beneficiaries | 150 |
| Number Of Non Hispanic White Beneficiaries | 275 |
| 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 | 275 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 0.8856 |