| National Provider Identifier [NPI]: | 1154559912 |
| Last Name Of The Provider | HAWTHORNE |
| First Name Of The Provider | CLINT |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 PLEASANT ST |
| Street Address 2 Of The Provider | #S-128 |
| City Of The Provider | DES MOINES |
| Zip Code Of The Provider | 503091406 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 811 |
| Number Of Medicare Beneficiaries | 739 |
| Total Submitted Charge Amount | 290198.02 |
| Total Medicare Allowed Amount | 111237.93 |
| Total Medicare Payment Amount | 82817.48 |
| Total Medicare Standardized Payment Amount | 88009.71 |
| 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 | 31 |
| Number Of Medical Services | 811 |
| Number Of Medicare Beneficiaries With Medical Services | 739 |
| Total Medical Submitted Charge Amount | 290198.02 |
| Total Medical Medicare Allowed Amount | 111237.93 |
| Total Medical Medicare Payment Amount | 82817.48 |
| Total Medical Medicare Standardized Payment Amount | 88009.71 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 167 |
| Number Of Beneficiaries Age 65 to 74 | 191 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 179 |
| Number Of Female Beneficiaries | 437 |
| Number Of Male Beneficiaries | 302 |
| Number Of Non Hispanic White Beneficiaries | 684 |
| Number Of Black or African American Beneficiaries | 36 |
| 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 | 517 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 222 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6213 |