| National Provider Identifier [NPI]: | 1770548265 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 405 E 7TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | THE DALLES |
| Zip Code Of The Provider | 970582607 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 2934 |
| Number Of Medicare Beneficiaries | 1317 |
| Total Submitted Charge Amount | 1015169 |
| Total Medicare Allowed Amount | 350879.34 |
| Total Medicare Payment Amount | 241628.45 |
| Total Medicare Standardized Payment Amount | 251752.07 |
| 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 | 29 |
| Number Of Medical Services | 2934 |
| Number Of Medicare Beneficiaries With Medical Services | 1317 |
| Total Medical Submitted Charge Amount | 1015169 |
| Total Medical Medicare Allowed Amount | 350879.34 |
| Total Medical Medicare Payment Amount | 241628.45 |
| Total Medical Medicare Standardized Payment Amount | 251752.07 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 445 |
| Number Of Beneficiaries Age 75 to 84 | 515 |
| Number Of Beneficiaries Age Greater 84 | 300 |
| Number Of Female Beneficiaries | 785 |
| Number Of Male Beneficiaries | 532 |
| Number Of Non Hispanic White Beneficiaries | 1245 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1210 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 107 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9016 |