National Provider Identifier [NPI]: |
1396737680 |
Last Name Of The Provider |
CLARK |
First Name Of The Provider |
TOREY |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
500 W LANIER AVE |
Street Address 2 Of The Provider |
SUITE 406 |
City Of The Provider |
FAYETTEVILLE |
Zip Code Of The Provider |
302147636 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Hematology/Oncology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
68 |
Number Of Services |
13570 |
Number Of Medicare Beneficiaries |
123 |
Total Submitted Charge Amount |
586435.35 |
Total Medicare Allowed Amount |
275529.78 |
Total Medicare Payment Amount |
210493.43 |
Total Medicare Standardized Payment Amount |
205964.87 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
34 |
Number Of Drug Services |
11189 |
Number Of Medicare Beneficiaries With Drug Services |
76 |
Total Drug Submitted ChargeAmount |
342383.35 |
Total Drug Medicare AllowedAmount |
169908.22 |
Total Drug Medicare PaymentAmount |
129832.87 |
Total Drug Medicare Standardized Payment Amount |
129832.87 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
34 |
Number Of Medical Services |
2381 |
Number Of Medicare Beneficiaries With Medical Services |
123 |
Total Medical Submitted Charge Amount |
244052 |
Total Medical Medicare Allowed Amount |
105621.56 |
Total Medical Medicare Payment Amount |
80660.56 |
Total Medical Medicare Standardized Payment Amount |
76132 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
23 |
Number Of Beneficiaries Age 65 to 74 |
58 |
Number Of Beneficiaries Age 75 to 84 |
27 |
Number Of Beneficiaries Age Greater 84 |
15 |
Number Of Female Beneficiaries |
85 |
Number Of Male Beneficiaries |
38 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
76 |
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 |
92 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
31 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
|
Percent Of With Cancer |
52 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
41 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
16 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.4846 |