| National Provider Identifier [NPI]: | 1336103563 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | LOWELL |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 212 S FLORIDA ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BUSHNELL |
| Zip Code Of The Provider | 335136703 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Geriatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 148 |
| Number Of Services | 6703 |
| Number Of Medicare Beneficiaries | 752 |
| Total Submitted Charge Amount | 421634.11 |
| Total Medicare Allowed Amount | 202885.5 |
| Total Medicare Payment Amount | 174873.85 |
| Total Medicare Standardized Payment Amount | 175797.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 50 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 4823 |
| Total Drug Medicare AllowedAmount | 1857.92 |
| Total Drug Medicare PaymentAmount | 1453.14 |
| Total Drug Medicare Standardized Payment Amount | 1453.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 136 |
| Number Of Medical Services | 6653 |
| Number Of Medicare Beneficiaries With Medical Services | 752 |
| Total Medical Submitted Charge Amount | 416811.11 |
| Total Medical Medicare Allowed Amount | 201027.58 |
| Total Medical Medicare Payment Amount | 173420.71 |
| Total Medical Medicare Standardized Payment Amount | 174343.94 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 132 |
| Number Of Beneficiaries Age 65 to 74 | 200 |
| Number Of Beneficiaries Age 75 to 84 | 206 |
| Number Of Beneficiaries Age Greater 84 | 214 |
| Number Of Female Beneficiaries | 434 |
| Number Of Male Beneficiaries | 318 |
| Number Of Non Hispanic White Beneficiaries | 683 |
| Number Of Black or African American Beneficiaries | 49 |
| 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 | 526 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 226 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 33 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7766 |