| National Provider Identifier [NPI]: | 1942265244 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | CHRISTOPHER |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | CRNA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 161 MOUNT PELIA RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARTIN |
| Zip Code Of The Provider | 382373811 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | CRNA |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 182 |
| Number Of Medicare Beneficiaries | 168 |
| Total Submitted Charge Amount | 53460 |
| Total Medicare Allowed Amount | 36147.89 |
| Total Medicare Payment Amount | 27801.49 |
| Total Medicare Standardized Payment Amount | 29388.32 |
| 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 | 33 |
| Number Of Medical Services | 182 |
| Number Of Medicare Beneficiaries With Medical Services | 168 |
| Total Medical Submitted Charge Amount | 53460 |
| Total Medical Medicare Allowed Amount | 36147.89 |
| Total Medical Medicare Payment Amount | 27801.49 |
| Total Medical Medicare Standardized Payment Amount | 29388.32 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 61 |
| Number Of Beneficiaries Age 75 to 84 | 44 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 93 |
| Number Of Male Beneficiaries | 75 |
| Number Of Non Hispanic White Beneficiaries | 150 |
| Number Of Black or African American Beneficiaries | 18 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 105 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 63 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.32 |