National Provider Identifier [NPI]: |
1942269873 |
Last Name Of The Provider |
KELLY |
First Name Of The Provider |
DONALD |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
P.A. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2121 E HARMONY RD |
Street Address 2 Of The Provider |
STE 330 |
City Of The Provider |
FORT COLLINS |
Zip Code Of The Provider |
805283400 |
State Code Of The Provider |
CO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
40 |
Number Of Services |
78 |
Number Of Medicare Beneficiaries |
68 |
Total Submitted Charge Amount |
113739.5 |
Total Medicare Allowed Amount |
8195.17 |
Total Medicare Payment Amount |
6279.46 |
Total Medicare Standardized Payment Amount |
6357.36 |
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 |
40 |
Number Of Medical Services |
78 |
Number Of Medicare Beneficiaries With Medical Services |
68 |
Total Medical Submitted Charge Amount |
113739.5 |
Total Medical Medicare Allowed Amount |
8195.17 |
Total Medical Medicare Payment Amount |
6279.46 |
Total Medical Medicare Standardized Payment Amount |
6357.36 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
20 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
21 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
31 |
Number Of Male Beneficiaries |
37 |
Number Of Non Hispanic White Beneficiaries |
54 |
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 |
47 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
21 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
19 |
Percent Of With Heart Failure |
29 |
Percent Of With Chronic Kidney Disease |
46 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
38 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
3.2915 |