| National Provider Identifier [NPI]: | 1205037611 |
| Last Name Of The Provider | DECLERK |
| First Name Of The Provider | GEORGE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2603 W PLEASANT GROVE RD |
| Street Address 2 Of The Provider | SUITE 109 |
| City Of The Provider | ROGERS |
| Zip Code Of The Provider | 727585804 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 541 |
| Number Of Medicare Beneficiaries | 79 |
| Total Submitted Charge Amount | 58068 |
| Total Medicare Allowed Amount | 21913.54 |
| Total Medicare Payment Amount | 15276.94 |
| Total Medicare Standardized Payment Amount | 16930.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 133 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 10126 |
| Total Drug Medicare AllowedAmount | 3493.69 |
| Total Drug Medicare PaymentAmount | 3359.42 |
| Total Drug Medicare Standardized Payment Amount | 3359.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 408 |
| Number Of Medicare Beneficiaries With Medical Services | 79 |
| Total Medical Submitted Charge Amount | 47942 |
| Total Medical Medicare Allowed Amount | 18419.85 |
| Total Medical Medicare Payment Amount | 11917.52 |
| Total Medical Medicare Standardized Payment Amount | 13571.48 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 39 |
| Number Of Beneficiaries Age 75 to 84 | 18 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 40 |
| Number Of Male Beneficiaries | 39 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.8201 |