| National Provider Identifier [NPI]: | 1770707598 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6934 AVIATION BLVD STE B |
| Street Address 2 Of The Provider | MDICS |
| City Of The Provider | GLEN BURNIE |
| Zip Code Of The Provider | 21061 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 1528 |
| Number Of Medicare Beneficiaries | 695 |
| Total Submitted Charge Amount | 256367 |
| Total Medicare Allowed Amount | 161002.28 |
| Total Medicare Payment Amount | 123211.28 |
| Total Medicare Standardized Payment Amount | 117872.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 1528 |
| Number Of Medicare Beneficiaries With Medical Services | 695 |
| Total Medical Submitted Charge Amount | 256367 |
| Total Medical Medicare Allowed Amount | 161002.28 |
| Total Medical Medicare Payment Amount | 123211.28 |
| Total Medical Medicare Standardized Payment Amount | 117872.76 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 150 |
| Number Of Beneficiaries Age 75 to 84 | 224 |
| Number Of Beneficiaries Age Greater 84 | 267 |
| Number Of Female Beneficiaries | 461 |
| Number Of Male Beneficiaries | 234 |
| Number Of Non Hispanic White Beneficiaries | 521 |
| Number Of Black or African American Beneficiaries | 157 |
| 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 | 519 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 176 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 44 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.0102 |