| National Provider Identifier [NPI]: | 1720179583 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | EILEEN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2050 PFINGSTEN RD |
| Street Address 2 Of The Provider | SUITE 360 |
| City Of The Provider | GLENVIEW |
| Zip Code Of The Provider | 600261324 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 3502 |
| Number Of Medicare Beneficiaries | 2072 |
| Total Submitted Charge Amount | 363427 |
| Total Medicare Allowed Amount | 121322.12 |
| Total Medicare Payment Amount | 91572.69 |
| Total Medicare Standardized Payment Amount | 86191.3 |
| 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 | 25 |
| Number Of Medical Services | 3502 |
| Number Of Medicare Beneficiaries With Medical Services | 2072 |
| Total Medical Submitted Charge Amount | 363427 |
| Total Medical Medicare Allowed Amount | 121322.12 |
| Total Medical Medicare Payment Amount | 91572.69 |
| Total Medical Medicare Standardized Payment Amount | 86191.3 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 116 |
| Number Of Beneficiaries Age 65 to 74 | 572 |
| Number Of Beneficiaries Age 75 to 84 | 714 |
| Number Of Beneficiaries Age Greater 84 | 670 |
| Number Of Female Beneficiaries | 1262 |
| Number Of Male Beneficiaries | 810 |
| Number Of Non Hispanic White Beneficiaries | 1846 |
| Number Of Black or African American Beneficiaries | 68 |
| Number Of AsianPacific Islander Beneficiaries | 84 |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1764 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 308 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.6302 |