| National Provider Identifier [NPI]: | 1073695037 |
| Last Name Of The Provider | FRIESEN |
| First Name Of The Provider | CLAYTON |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3515 RICHMOND CIRCLE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND ISLAND |
| Zip Code Of The Provider | 688034965 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 89 |
| Number Of Services | 7133 |
| Number Of Medicare Beneficiaries | 2680 |
| Total Submitted Charge Amount | 1413007 |
| Total Medicare Allowed Amount | 638419.58 |
| Total Medicare Payment Amount | 485383.89 |
| Total Medicare Standardized Payment Amount | 523774.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 645 |
| Number Of Medicare Beneficiaries With Drug Services | 162 |
| Total Drug Submitted ChargeAmount | 56760 |
| Total Drug Medicare AllowedAmount | 34132.47 |
| Total Drug Medicare PaymentAmount | 26759.68 |
| Total Drug Medicare Standardized Payment Amount | 26759.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 88 |
| Number Of Medical Services | 6488 |
| Number Of Medicare Beneficiaries With Medical Services | 2680 |
| Total Medical Submitted Charge Amount | 1356247 |
| Total Medical Medicare Allowed Amount | 604287.11 |
| Total Medical Medicare Payment Amount | 458624.21 |
| Total Medical Medicare Standardized Payment Amount | 497014.68 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 213 |
| Number Of Beneficiaries Age 65 to 74 | 867 |
| Number Of Beneficiaries Age 75 to 84 | 971 |
| Number Of Beneficiaries Age Greater 84 | 629 |
| Number Of Female Beneficiaries | 1317 |
| Number Of Male Beneficiaries | 1363 |
| Number Of Non Hispanic White Beneficiaries | 2590 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 60 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2252 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 428 |
| Percent Of With Atrial Fibrillation | 35 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4594 |