| National Provider Identifier [NPI]: | 1396828885 |
| Last Name Of The Provider | CLARK |
| First Name Of The Provider | SHARON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MSW, LCSW |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1036 WESTCHESTER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHARLOTTE |
| Zip Code Of The Provider | 282056344 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Licensed Clinical Social Worker |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 5 |
| Number Of Services | 730.4 |
| Number Of Medicare Beneficiaries | 168 |
| Total Submitted Charge Amount | 100536.94 |
| Total Medicare Allowed Amount | 41825.82 |
| Total Medicare Payment Amount | 31205.06 |
| Total Medicare Standardized Payment Amount | 32048.2 |
| 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 | 5 |
| Number Of Medical Services | 730.4 |
| Number Of Medicare Beneficiaries With Medical Services | 168 |
| Total Medical Submitted Charge Amount | 100536.94 |
| Total Medical Medicare Allowed Amount | 41825.82 |
| Total Medical Medicare Payment Amount | 31205.06 |
| Total Medical Medicare Standardized Payment Amount | 32048.2 |
| Average Age Of Beneficiaries | 47 |
| Number Of Beneficiaries Age Less65 | 152 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 37 |
| Number Of Non Hispanic White Beneficiaries | 127 |
| 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 | 58 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 110 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 66 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 10 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 33 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1447 |