| National Provider Identifier [NPI]: | 1851354567 |
| Last Name Of The Provider | WOLBOLDT |
| First Name Of The Provider | CLINTON |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7601 QUAKER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LUBBOCK |
| Zip Code Of The Provider | 794243360 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 1631 |
| Number Of Medicare Beneficiaries | 456 |
| Total Submitted Charge Amount | 148747 |
| Total Medicare Allowed Amount | 70225.29 |
| Total Medicare Payment Amount | 46282.35 |
| Total Medicare Standardized Payment Amount | 51041.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 260 |
| Number Of Medicare Beneficiaries With Drug Services | 66 |
| Total Drug Submitted ChargeAmount | 8898 |
| Total Drug Medicare AllowedAmount | 2007.55 |
| Total Drug Medicare PaymentAmount | 1636.94 |
| Total Drug Medicare Standardized Payment Amount | 1636.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 1371 |
| Number Of Medicare Beneficiaries With Medical Services | 455 |
| Total Medical Submitted Charge Amount | 139849 |
| Total Medical Medicare Allowed Amount | 68217.74 |
| Total Medical Medicare Payment Amount | 44645.41 |
| Total Medical Medicare Standardized Payment Amount | 49404.73 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 185 |
| Number Of Beneficiaries Age 75 to 84 | 147 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 296 |
| Number Of Male Beneficiaries | 160 |
| Number Of Non Hispanic White Beneficiaries | 382 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 59 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 399 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0373 |