| National Provider Identifier [NPI]: | 1548249436 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7550 ASSUNTA CT |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAIRHOPE |
| Zip Code Of The Provider | 365323069 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 97 |
| Number Of Services | 10363 |
| Number Of Medicare Beneficiaries | 1341 |
| Total Submitted Charge Amount | 635579.22 |
| Total Medicare Allowed Amount | 552997.76 |
| Total Medicare Payment Amount | 399349.25 |
| Total Medicare Standardized Payment Amount | 437817.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 287 |
| Number Of Medicare Beneficiaries With Drug Services | 102 |
| Total Drug Submitted ChargeAmount | 34749.58 |
| Total Drug Medicare AllowedAmount | 34483.64 |
| Total Drug Medicare PaymentAmount | 26702.77 |
| Total Drug Medicare Standardized Payment Amount | 26702.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 94 |
| Number Of Medical Services | 10076 |
| Number Of Medicare Beneficiaries With Medical Services | 1341 |
| Total Medical Submitted Charge Amount | 600829.64 |
| Total Medical Medicare Allowed Amount | 518514.12 |
| Total Medical Medicare Payment Amount | 372646.48 |
| Total Medical Medicare Standardized Payment Amount | 411114.3 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 595 |
| Number Of Beneficiaries Age 75 to 84 | 493 |
| Number Of Beneficiaries Age Greater 84 | 217 |
| Number Of Female Beneficiaries | 576 |
| Number Of Male Beneficiaries | 765 |
| Number Of Non Hispanic White Beneficiaries | 1302 |
| Number Of Black or African American Beneficiaries | 12 |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1316 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9378 |