| National Provider Identifier [NPI]: | 1750483699 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | RAYMOND |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 350 SALEM ROAD |
| Street Address 2 Of The Provider | STE 1 |
| City Of The Provider | CONWAY |
| Zip Code Of The Provider | 72034 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 3718 |
| Number Of Medicare Beneficiaries | 359 |
| Total Submitted Charge Amount | 400825 |
| Total Medicare Allowed Amount | 276672.51 |
| Total Medicare Payment Amount | 216224.85 |
| Total Medicare Standardized Payment Amount | 232327.62 |
| 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 | 11 |
| Number Of Medical Services | 3718 |
| Number Of Medicare Beneficiaries With Medical Services | 359 |
| Total Medical Submitted Charge Amount | 400825 |
| Total Medical Medicare Allowed Amount | 276672.51 |
| Total Medical Medicare Payment Amount | 216224.85 |
| Total Medical Medicare Standardized Payment Amount | 232327.62 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 103 |
| Number Of Beneficiaries Age 75 to 84 | 105 |
| Number Of Beneficiaries Age Greater 84 | 99 |
| Number Of Female Beneficiaries | 248 |
| Number Of Male Beneficiaries | 111 |
| Number Of Non Hispanic White Beneficiaries | 345 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 150 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 209 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 48 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 1.6829 |