| National Provider Identifier [NPI]: | 1790766178 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | HOLLIS |
| 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 | 1000 S 12TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MURRAY |
| Zip Code Of The Provider | 420719303 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 12447 |
| Number Of Medicare Beneficiaries | 1432 |
| Total Submitted Charge Amount | 888952.56 |
| Total Medicare Allowed Amount | 344240.29 |
| Total Medicare Payment Amount | 253174.51 |
| Total Medicare Standardized Payment Amount | 273179.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 1886 |
| Number Of Medicare Beneficiaries With Drug Services | 442 |
| Total Drug Submitted ChargeAmount | 44645.96 |
| Total Drug Medicare AllowedAmount | 14311.31 |
| Total Drug Medicare PaymentAmount | 13081.45 |
| Total Drug Medicare Standardized Payment Amount | 13081.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 155 |
| Number Of Medical Services | 10561 |
| Number Of Medicare Beneficiaries With Medical Services | 1432 |
| Total Medical Submitted Charge Amount | 844306.6 |
| Total Medical Medicare Allowed Amount | 329928.98 |
| Total Medical Medicare Payment Amount | 240093.06 |
| Total Medical Medicare Standardized Payment Amount | 260098.36 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 225 |
| Number Of Beneficiaries Age 65 to 74 | 576 |
| Number Of Beneficiaries Age 75 to 84 | 410 |
| Number Of Beneficiaries Age Greater 84 | 221 |
| Number Of Female Beneficiaries | 824 |
| Number Of Male Beneficiaries | 608 |
| Number Of Non Hispanic White Beneficiaries | 1381 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 1144 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 288 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1235 |