| National Provider Identifier [NPI]: | 1386730836 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1216 RYANS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WORTHINGTON |
| Zip Code Of The Provider | 561871722 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 203 |
| Number Of Services | 18398 |
| Number Of Medicare Beneficiaries | 832 |
| Total Submitted Charge Amount | 532500.76 |
| Total Medicare Allowed Amount | 524597.46 |
| Total Medicare Payment Amount | 396383 |
| Total Medicare Standardized Payment Amount | 399037.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 44 |
| Number Of Drug Services | 9344 |
| Number Of Medicare Beneficiaries With Drug Services | 282 |
| Total Drug Submitted ChargeAmount | 226953.19 |
| Total Drug Medicare AllowedAmount | 226236.26 |
| Total Drug Medicare PaymentAmount | 180381.15 |
| Total Drug Medicare Standardized Payment Amount | 180381.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 159 |
| Number Of Medical Services | 9054 |
| Number Of Medicare Beneficiaries With Medical Services | 831 |
| Total Medical Submitted Charge Amount | 305547.57 |
| Total Medical Medicare Allowed Amount | 298361.2 |
| Total Medical Medicare Payment Amount | 216001.85 |
| Total Medical Medicare Standardized Payment Amount | 218655.92 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 85 |
| Number Of Beneficiaries Age 65 to 74 | 205 |
| Number Of Beneficiaries Age 75 to 84 | 289 |
| Number Of Beneficiaries Age Greater 84 | 253 |
| Number Of Female Beneficiaries | 468 |
| Number Of Male Beneficiaries | 364 |
| Number Of Non Hispanic White Beneficiaries | 786 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 719 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 113 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 2 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.1702 |