| National Provider Identifier [NPI]: | 1497980254 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | BRIANNE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 709 W OAK |
| Street Address 2 Of The Provider | |
| City Of The Provider | ASHLAND |
| Zip Code Of The Provider | 67831 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 554 |
| Number Of Medicare Beneficiaries | 126 |
| Total Submitted Charge Amount | 55373.15 |
| Total Medicare Allowed Amount | 34077.82 |
| Total Medicare Payment Amount | 22335.83 |
| Total Medicare Standardized Payment Amount | 24458.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 442 |
| Total Drug Medicare AllowedAmount | 176.83 |
| Total Drug Medicare PaymentAmount | 159.58 |
| Total Drug Medicare Standardized Payment Amount | 159.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 528 |
| Number Of Medicare Beneficiaries With Medical Services | 125 |
| Total Medical Submitted Charge Amount | 54931.15 |
| Total Medical Medicare Allowed Amount | 33900.99 |
| Total Medical Medicare Payment Amount | 22176.25 |
| Total Medical Medicare Standardized Payment Amount | 24298.47 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 43 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 72 |
| Number Of Male Beneficiaries | 54 |
| 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 | 106 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 26 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1379 |