| National Provider Identifier [NPI]: | 1699739946 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4000 JOHNSON RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | STEUBENVILLE |
| Zip Code Of The Provider | 439522300 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 204 |
| Number Of Services | 7841 |
| Number Of Medicare Beneficiaries | 3559 |
| Total Submitted Charge Amount | 666758 |
| Total Medicare Allowed Amount | 187890.98 |
| Total Medicare Payment Amount | 145362.92 |
| Total Medicare Standardized Payment Amount | 149595.73 |
| 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 | 204 |
| Number Of Medical Services | 7841 |
| Number Of Medicare Beneficiaries With Medical Services | 3559 |
| Total Medical Submitted Charge Amount | 666758 |
| Total Medical Medicare Allowed Amount | 187890.98 |
| Total Medical Medicare Payment Amount | 145362.92 |
| Total Medical Medicare Standardized Payment Amount | 149595.73 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 745 |
| Number Of Beneficiaries Age 65 to 74 | 1282 |
| Number Of Beneficiaries Age 75 to 84 | 988 |
| Number Of Beneficiaries Age Greater 84 | 544 |
| Number Of Female Beneficiaries | 2151 |
| Number Of Male Beneficiaries | 1408 |
| Number Of Non Hispanic White Beneficiaries | 3321 |
| Number Of Black or African American Beneficiaries | 182 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2449 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1110 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7638 |