National Provider Identifier [NPI]: |
1093704751 |
Last Name Of The Provider |
CLARK |
First Name Of The Provider |
MELVIN |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4212 N 16TH ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
PHOENIX |
Zip Code Of The Provider |
850165319 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Ophthalmology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
21 |
Number Of Services |
526 |
Number Of Medicare Beneficiaries |
223 |
Total Submitted Charge Amount |
375613.29 |
Total Medicare Allowed Amount |
89948.32 |
Total Medicare Payment Amount |
69344.82 |
Total Medicare Standardized Payment Amount |
69870.03 |
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 |
21 |
Number Of Medical Services |
526 |
Number Of Medicare Beneficiaries With Medical Services |
223 |
Total Medical Submitted Charge Amount |
375613.29 |
Total Medical Medicare Allowed Amount |
89948.32 |
Total Medical Medicare Payment Amount |
69344.82 |
Total Medical Medicare Standardized Payment Amount |
69870.03 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
39 |
Number Of Beneficiaries Age 65 to 74 |
95 |
Number Of Beneficiaries Age 75 to 84 |
78 |
Number Of Beneficiaries Age Greater 84 |
11 |
Number Of Female Beneficiaries |
141 |
Number Of Male Beneficiaries |
82 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
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 |
120 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
103 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
37 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
67 |
Percent Of With Hyperlipidemia |
43 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.8116 |