| National Provider Identifier [NPI]: | 1912172917 |
| Last Name Of The Provider | CLEMENTE |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6 MEDICAL PARK DR |
| Street Address 2 Of The Provider | SUITE 206 |
| City Of The Provider | MALTA |
| Zip Code Of The Provider | 120205061 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 428 |
| Number Of Medicare Beneficiaries | 91 |
| Total Submitted Charge Amount | 76238.35 |
| Total Medicare Allowed Amount | 30808.81 |
| Total Medicare Payment Amount | 24960.76 |
| Total Medicare Standardized Payment Amount | 23617.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 7604.72 |
| Total Drug Medicare AllowedAmount | 3645.23 |
| Total Drug Medicare PaymentAmount | 3572.16 |
| Total Drug Medicare Standardized Payment Amount | 3572.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 360 |
| Number Of Medicare Beneficiaries With Medical Services | 91 |
| Total Medical Submitted Charge Amount | 68633.63 |
| Total Medical Medicare Allowed Amount | 27163.58 |
| Total Medical Medicare Payment Amount | 21388.6 |
| Total Medical Medicare Standardized Payment Amount | 20045.48 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 38 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 75 |
| Number Of Male Beneficiaries | 16 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 56 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 35 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0773 |