| National Provider Identifier [NPI]: | 1659530004 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | JANE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1107 MEMORIAL DR |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | DALTON |
| Zip Code Of The Provider | 307208662 |
| 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 | 66 |
| Number Of Services | 5209 |
| Number Of Medicare Beneficiaries | 1620 |
| Total Submitted Charge Amount | 2033927 |
| Total Medicare Allowed Amount | 1523776.85 |
| Total Medicare Payment Amount | 1163759.73 |
| Total Medicare Standardized Payment Amount | 1267613.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 375 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 750 |
| Total Drug Medicare AllowedAmount | 667.69 |
| Total Drug Medicare PaymentAmount | 469.46 |
| Total Drug Medicare Standardized Payment Amount | 469.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 65 |
| Number Of Medical Services | 4834 |
| Number Of Medicare Beneficiaries With Medical Services | 1620 |
| Total Medical Submitted Charge Amount | 2033177 |
| Total Medical Medicare Allowed Amount | 1523109.16 |
| Total Medical Medicare Payment Amount | 1163290.27 |
| Total Medical Medicare Standardized Payment Amount | 1267144.33 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 162 |
| Number Of Beneficiaries Age 65 to 74 | 718 |
| Number Of Beneficiaries Age 75 to 84 | 557 |
| Number Of Beneficiaries Age Greater 84 | 183 |
| Number Of Female Beneficiaries | 705 |
| Number Of Male Beneficiaries | 915 |
| Number Of Non Hispanic White Beneficiaries | 1594 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1349 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 271 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0828 |