| National Provider Identifier [NPI]: | 1861656332 |
| Last Name Of The Provider | LARSEN |
| First Name Of The Provider | CLINT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 837 E. CEDAR ST |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | SOUTH BEND |
| Zip Code Of The Provider | 46617 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 1408 |
| Number Of Medicare Beneficiaries | 366 |
| Total Submitted Charge Amount | 215754 |
| Total Medicare Allowed Amount | 81069.72 |
| Total Medicare Payment Amount | 58787.42 |
| Total Medicare Standardized Payment Amount | 60150.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 455 |
| Total Drug Medicare AllowedAmount | 30.91 |
| Total Drug Medicare PaymentAmount | 21.31 |
| Total Drug Medicare Standardized Payment Amount | 21.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 1386 |
| Number Of Medicare Beneficiaries With Medical Services | 366 |
| Total Medical Submitted Charge Amount | 215299 |
| Total Medical Medicare Allowed Amount | 81038.81 |
| Total Medical Medicare Payment Amount | 58766.11 |
| Total Medical Medicare Standardized Payment Amount | 60129.1 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 122 |
| Number Of Beneficiaries Age 75 to 84 | 126 |
| Number Of Beneficiaries Age Greater 84 | 93 |
| Number Of Female Beneficiaries | 226 |
| Number Of Male Beneficiaries | 140 |
| Number Of Non Hispanic White Beneficiaries | 345 |
| 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 | 344 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.3104 |