Medicare Facts for Jon A. Clark, CRNA


National Provider Identifier [NPI]: 1285675702
Last Name Of The Provider CLARK
First Name Of The Provider JON
Middle Initial Of The Provider A
Credentials Of The Provider C.R.N.A.
Gender Of The Provider M
Entity Type Of The Provider I
Street Address 1 Of The Provider 955 S BAILEY AVE
Street Address 2 Of The Provider SHCH ANESTHESIA DEPT
City Of The Provider SOUTH HAVEN
Zip Code Of The Provider 490909701
State Code Of The Provider MI
Country Code Of The Provider US
Provider Type Of The Provider CRNA
Medicare Participation Indicator Y
Number Of HCPCS 36
Number Of Services 202
Number Of Medicare Beneficiaries 161
Total Submitted Charge Amount 120325.82
Total Medicare Allowed Amount 34249.08
Total Medicare Payment Amount 26100.9
Total Medicare Standardized Payment Amount 26606.11
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 36
Number Of Medical Services 202
Number Of Medicare Beneficiaries With Medical Services 161
Total Medical Submitted Charge Amount 120325.82
Total Medical Medicare Allowed Amount 34249.08
Total Medical Medicare Payment Amount 26100.9
Total Medical Medicare Standardized Payment Amount 26606.11
Average Age Of Beneficiaries 69
Number Of Beneficiaries Age Less65
Number Of Beneficiaries Age 65 to 74 68
Number Of Beneficiaries Age 75 to 84 53
Number Of Beneficiaries Age Greater 84
Number Of Female Beneficiaries 85
Number Of Male Beneficiaries 76
Number Of Non Hispanic White Beneficiaries 141
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 117
Number Of Beneficiaries With Medicare Medicaid Entitlement 44
Percent Of With Atrial Fibrillation 8
Percent Of With Alzheimers Disease or Dementia 11
Percent Of With Asthma
Percent Of With Cancer 12
Percent Of With Heart Failure 10
Percent Of With Chronic Kidney Disease 19
Percent Of With Chronic Obstructive Pulmonary Disease 12
Percent Of With Depression 24
Percent Of With Diabetes 24
Percent Of With Hyperlipidemia 47
Percent Of With Hypertension 59
Percent Of With Ischemic Heart Disease 27
Percent Of With Osteoporosis
Percent Of With Rheumatoid Arthritis Osteoarthritis 40
Percent Of With Schizophrenia Other PsychoticDisorders
Percent Of With Stroke
Average HCC Risk Score Of Beneficiaries 1.0383

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