| National Provider Identifier [NPI]: | 1669521522 |
| Last Name Of The Provider | EVANS |
| First Name Of The Provider | CLIFFORD |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2312 SOUTH DIXON ROAD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | KOKOMO |
| Zip Code Of The Provider | 469026423 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 96 |
| Number Of Services | 1288 |
| Number Of Medicare Beneficiaries | 349 |
| Total Submitted Charge Amount | 683594 |
| Total Medicare Allowed Amount | 145354.84 |
| Total Medicare Payment Amount | 111085.22 |
| Total Medicare Standardized Payment Amount | 120663.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 354 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 4082 |
| Total Drug Medicare AllowedAmount | 1748.43 |
| Total Drug Medicare PaymentAmount | 1342.86 |
| Total Drug Medicare Standardized Payment Amount | 1342.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 94 |
| Number Of Medical Services | 934 |
| Number Of Medicare Beneficiaries With Medical Services | 348 |
| Total Medical Submitted Charge Amount | 679512 |
| Total Medical Medicare Allowed Amount | 143606.41 |
| Total Medical Medicare Payment Amount | 109742.36 |
| Total Medical Medicare Standardized Payment Amount | 119321.01 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | 115 |
| Number Of Beneficiaries Age 75 to 84 | 97 |
| Number Of Beneficiaries Age Greater 84 | 44 |
| Number Of Female Beneficiaries | 242 |
| Number Of Male Beneficiaries | 107 |
| Number Of Non Hispanic White Beneficiaries | 319 |
| 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 | 253 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 71 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3879 |