| National Provider Identifier [NPI]: | 1184669350 |
| Last Name Of The Provider | WILLIAMS |
| First Name Of The Provider | BENISE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 303 SMITH STREET |
| Street Address 2 Of The Provider | CLARK-HOLDER CLINIC, P.A. |
| City Of The Provider | LAGRANGE |
| Zip Code Of The Provider | 30240 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 7060 |
| Number Of Medicare Beneficiaries | 575 |
| Total Submitted Charge Amount | 632072 |
| Total Medicare Allowed Amount | 158704.46 |
| Total Medicare Payment Amount | 107924.14 |
| Total Medicare Standardized Payment Amount | 108154.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 22 |
| Number Of Drug Services | 3394 |
| Number Of Medicare Beneficiaries With Drug Services | 294 |
| Total Drug Submitted ChargeAmount | 82464 |
| Total Drug Medicare AllowedAmount | 7718.21 |
| Total Drug Medicare PaymentAmount | 5905.02 |
| Total Drug Medicare Standardized Payment Amount | 5905.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 3666 |
| Number Of Medicare Beneficiaries With Medical Services | 575 |
| Total Medical Submitted Charge Amount | 549608 |
| Total Medical Medicare Allowed Amount | 150986.25 |
| Total Medical Medicare Payment Amount | 102019.12 |
| Total Medical Medicare Standardized Payment Amount | 102249.65 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 229 |
| Number Of Beneficiaries Age 65 to 74 | 195 |
| Number Of Beneficiaries Age 75 to 84 | 119 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 403 |
| Number Of Male Beneficiaries | 172 |
| Number Of Non Hispanic White Beneficiaries | 280 |
| Number Of Black or African American Beneficiaries | 283 |
| 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 | 329 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 246 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3051 |