| National Provider Identifier [NPI]: | 1538115423 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2002 MEDICAL PKWY |
| Street Address 2 Of The Provider | STE 235 |
| City Of The Provider | ANNAPOLIS |
| Zip Code Of The Provider | 214013046 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 198 |
| Number Of Services | 13930 |
| Number Of Medicare Beneficiaries | 3134 |
| Total Submitted Charge Amount | 1861810 |
| Total Medicare Allowed Amount | 551738.72 |
| Total Medicare Payment Amount | 425444.19 |
| Total Medicare Standardized Payment Amount | 397113.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 9082 |
| Number Of Medicare Beneficiaries With Drug Services | 251 |
| Total Drug Submitted ChargeAmount | 20199 |
| Total Drug Medicare AllowedAmount | 6269.2 |
| Total Drug Medicare PaymentAmount | 4677.52 |
| Total Drug Medicare Standardized Payment Amount | 4677.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 194 |
| Number Of Medical Services | 4848 |
| Number Of Medicare Beneficiaries With Medical Services | 3134 |
| Total Medical Submitted Charge Amount | 1841611 |
| Total Medical Medicare Allowed Amount | 545469.52 |
| Total Medical Medicare Payment Amount | 420766.67 |
| Total Medical Medicare Standardized Payment Amount | 392436.15 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 340 |
| Number Of Beneficiaries Age 65 to 74 | 1285 |
| Number Of Beneficiaries Age 75 to 84 | 996 |
| Number Of Beneficiaries Age Greater 84 | 513 |
| Number Of Female Beneficiaries | 1926 |
| Number Of Male Beneficiaries | 1208 |
| Number Of Non Hispanic White Beneficiaries | 2525 |
| Number Of Black or African American Beneficiaries | 511 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2811 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 323 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.4996 |