| National Provider Identifier [NPI]: | 1083647838 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | TRAVIS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 820 N CHELAN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WENATCHEE |
| Zip Code Of The Provider | 988012028 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 146 |
| Number Of Services | 2849 |
| Number Of Medicare Beneficiaries | 751 |
| Total Submitted Charge Amount | 748441.96 |
| Total Medicare Allowed Amount | 307905.18 |
| Total Medicare Payment Amount | 229994.77 |
| Total Medicare Standardized Payment Amount | 236178.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 20 |
| Number Of Drug Services | 657 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 139365.4 |
| Total Drug Medicare AllowedAmount | 62083.94 |
| Total Drug Medicare PaymentAmount | 48643.69 |
| Total Drug Medicare Standardized Payment Amount | 48643.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 126 |
| Number Of Medical Services | 2192 |
| Number Of Medicare Beneficiaries With Medical Services | 751 |
| Total Medical Submitted Charge Amount | 609076.56 |
| Total Medical Medicare Allowed Amount | 245821.24 |
| Total Medical Medicare Payment Amount | 181351.08 |
| Total Medical Medicare Standardized Payment Amount | 187534.55 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 92 |
| Number Of Beneficiaries Age 65 to 74 | 319 |
| Number Of Beneficiaries Age 75 to 84 | 246 |
| Number Of Beneficiaries Age Greater 84 | 94 |
| Number Of Female Beneficiaries | 249 |
| Number Of Male Beneficiaries | 502 |
| Number Of Non Hispanic White Beneficiaries | 680 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 46 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 621 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 130 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1861 |