| National Provider Identifier [NPI]: | 1174612337 |
| Last Name Of The Provider | DIFFENDAFFER |
| First Name Of The Provider | CLARK |
| 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 | 1207 W 4TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORTH PLATTE |
| Zip Code Of The Provider | 691013719 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 212 |
| Number Of Services | 9160 |
| Number Of Medicare Beneficiaries | 4395 |
| Total Submitted Charge Amount | 1803281 |
| Total Medicare Allowed Amount | 290377.9 |
| Total Medicare Payment Amount | 228367.98 |
| Total Medicare Standardized Payment Amount | 245140.19 |
| 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 | 212 |
| Number Of Medical Services | 9160 |
| Number Of Medicare Beneficiaries With Medical Services | 4395 |
| Total Medical Submitted Charge Amount | 1803281 |
| Total Medical Medicare Allowed Amount | 290377.9 |
| Total Medical Medicare Payment Amount | 228367.98 |
| Total Medical Medicare Standardized Payment Amount | 245140.19 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 536 |
| Number Of Beneficiaries Age 65 to 74 | 1654 |
| Number Of Beneficiaries Age 75 to 84 | 1390 |
| Number Of Beneficiaries Age Greater 84 | 815 |
| Number Of Female Beneficiaries | 2832 |
| Number Of Male Beneficiaries | 1563 |
| Number Of Non Hispanic White Beneficiaries | 4233 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | 42 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3579 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 816 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3222 |