| National Provider Identifier [NPI]: | 1154565638 |
| Last Name Of The Provider | CLEBAK |
| First Name Of The Provider | KARL |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 112 CROFTON PL |
| Street Address 2 Of The Provider | |
| City Of The Provider | PALMYRA |
| Zip Code Of The Provider | 229633363 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 3261 |
| Number Of Medicare Beneficiaries | 391 |
| Total Submitted Charge Amount | 437709.08 |
| Total Medicare Allowed Amount | 189021.29 |
| Total Medicare Payment Amount | 141202.71 |
| Total Medicare Standardized Payment Amount | 143789.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 279 |
| Number Of Medicare Beneficiaries With Drug Services | 151 |
| Total Drug Submitted ChargeAmount | 7252 |
| Total Drug Medicare AllowedAmount | 3183.49 |
| Total Drug Medicare PaymentAmount | 3041.9 |
| Total Drug Medicare Standardized Payment Amount | 3041.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 2982 |
| Number Of Medicare Beneficiaries With Medical Services | 391 |
| Total Medical Submitted Charge Amount | 430457.08 |
| Total Medical Medicare Allowed Amount | 185837.8 |
| Total Medical Medicare Payment Amount | 138160.81 |
| Total Medical Medicare Standardized Payment Amount | 140748.03 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 190 |
| Number Of Beneficiaries Age 75 to 84 | 131 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 202 |
| Number Of Male Beneficiaries | 189 |
| Number Of Non Hispanic White Beneficiaries | 344 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 343 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0214 |