| National Provider Identifier [NPI]: | 1881676286 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 929 N SAINT FRANCIS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WICHITA |
| Zip Code Of The Provider | 672143821 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 205 |
| Number Of Services | 7247 |
| Number Of Medicare Beneficiaries | 4962 |
| Total Submitted Charge Amount | 574981 |
| Total Medicare Allowed Amount | 189128.56 |
| Total Medicare Payment Amount | 147241.24 |
| Total Medicare Standardized Payment Amount | 154746.3 |
| 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 | 205 |
| Number Of Medical Services | 7247 |
| Number Of Medicare Beneficiaries With Medical Services | 4962 |
| Total Medical Submitted Charge Amount | 574981 |
| Total Medical Medicare Allowed Amount | 189128.56 |
| Total Medical Medicare Payment Amount | 147241.24 |
| Total Medical Medicare Standardized Payment Amount | 154746.3 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 1029 |
| Number Of Beneficiaries Age 65 to 74 | 1669 |
| Number Of Beneficiaries Age 75 to 84 | 1418 |
| Number Of Beneficiaries Age Greater 84 | 846 |
| Number Of Female Beneficiaries | 2982 |
| Number Of Male Beneficiaries | 1980 |
| Number Of Non Hispanic White Beneficiaries | 4424 |
| Number Of Black or African American Beneficiaries | 281 |
| Number Of AsianPacific Islander Beneficiaries | 34 |
| Number Of Hispanic Beneficiaries | 144 |
| Number Of American Indian Alaska Native Beneficiaries | 38 |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3717 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1245 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7173 |