| National Provider Identifier [NPI]: | 1962472498 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 65 ROCHESTER HILL RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROCHESTER |
| Zip Code Of The Provider | 038673231 |
| State Code Of The Provider | NH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 984 |
| Number Of Medicare Beneficiaries | 437 |
| Total Submitted Charge Amount | 122148 |
| Total Medicare Allowed Amount | 87963.93 |
| Total Medicare Payment Amount | 60490.2 |
| Total Medicare Standardized Payment Amount | 66303.79 |
| 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 | 14 |
| Number Of Medical Services | 984 |
| Number Of Medicare Beneficiaries With Medical Services | 437 |
| Total Medical Submitted Charge Amount | 122148 |
| Total Medical Medicare Allowed Amount | 87963.93 |
| Total Medical Medicare Payment Amount | 60490.2 |
| Total Medical Medicare Standardized Payment Amount | 66303.79 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 232 |
| Number Of Beneficiaries Age 75 to 84 | 139 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 254 |
| Number Of Male Beneficiaries | 183 |
| Number Of Non Hispanic White Beneficiaries | 423 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 409 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9462 |