| National Provider Identifier [NPI]: | 1629077987 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | CARY |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10901 BAKERS CROSSING RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BLUFF DALE |
| Zip Code Of The Provider | 764335111 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 1031 |
| Number Of Medicare Beneficiaries | 565 |
| Total Submitted Charge Amount | 674391 |
| Total Medicare Allowed Amount | 109448.44 |
| Total Medicare Payment Amount | 83208.88 |
| Total Medicare Standardized Payment Amount | 85404.38 |
| 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 | 1031 |
| Number Of Medicare Beneficiaries With Medical Services | 565 |
| Total Medical Submitted Charge Amount | 674391 |
| Total Medical Medicare Allowed Amount | 109448.44 |
| Total Medical Medicare Payment Amount | 83208.88 |
| Total Medical Medicare Standardized Payment Amount | 85404.38 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 122 |
| Number Of Beneficiaries Age 65 to 74 | 170 |
| Number Of Beneficiaries Age 75 to 84 | 166 |
| Number Of Beneficiaries Age Greater 84 | 107 |
| Number Of Female Beneficiaries | 353 |
| Number Of Male Beneficiaries | 212 |
| Number Of Non Hispanic White Beneficiaries | 512 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 397 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 168 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.3725 |