| National Provider Identifier [NPI]: | 1053366211 |
| Last Name Of The Provider | BOUDREAUX |
| First Name Of The Provider | CLARENCE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 103 SOLANA ROAD SUITE B |
| Street Address 2 Of The Provider | |
| City Of The Provider | PONTE VEDRA BEACH |
| Zip Code Of The Provider | 32082 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 10133 |
| Number Of Medicare Beneficiaries | 2087 |
| Total Submitted Charge Amount | 914806.85 |
| Total Medicare Allowed Amount | 640862.96 |
| Total Medicare Payment Amount | 457183.69 |
| Total Medicare Standardized Payment Amount | 458626.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 96 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 22787 |
| Total Drug Medicare AllowedAmount | 16996 |
| Total Drug Medicare PaymentAmount | 13116.58 |
| Total Drug Medicare Standardized Payment Amount | 13116.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 96 |
| Number Of Medical Services | 10037 |
| Number Of Medicare Beneficiaries With Medical Services | 2087 |
| Total Medical Submitted Charge Amount | 892019.85 |
| Total Medical Medicare Allowed Amount | 623866.96 |
| Total Medical Medicare Payment Amount | 444067.11 |
| Total Medical Medicare Standardized Payment Amount | 445510.1 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 1049 |
| Number Of Beneficiaries Age 75 to 84 | 717 |
| Number Of Beneficiaries Age Greater 84 | 279 |
| Number Of Female Beneficiaries | 930 |
| Number Of Male Beneficiaries | 1157 |
| Number Of Non Hispanic White Beneficiaries | 2005 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2064 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9121 |