| National Provider Identifier [NPI]: | 1528095379 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | FRANK |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D., PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2650 RIDGE AVE |
| Street Address 2 Of The Provider | EVANSTON HOSPITAL |
| City Of The Provider | EVANSTON |
| Zip Code Of The Provider | 602011718 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 789 |
| Number Of Medicare Beneficiaries | 430 |
| Total Submitted Charge Amount | 710429.3 |
| Total Medicare Allowed Amount | 77525.53 |
| Total Medicare Payment Amount | 59190.49 |
| Total Medicare Standardized Payment Amount | 54137.92 |
| 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 | 104 |
| Number Of Medical Services | 789 |
| Number Of Medicare Beneficiaries With Medical Services | 430 |
| Total Medical Submitted Charge Amount | 710429.3 |
| Total Medical Medicare Allowed Amount | 77525.53 |
| Total Medical Medicare Payment Amount | 59190.49 |
| Total Medical Medicare Standardized Payment Amount | 54137.92 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 173 |
| Number Of Beneficiaries Age 75 to 84 | 133 |
| Number Of Beneficiaries Age Greater 84 | 72 |
| Number Of Female Beneficiaries | 238 |
| Number Of Male Beneficiaries | 192 |
| Number Of Non Hispanic White Beneficiaries | 372 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 379 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5313 |