| National Provider Identifier [NPI]: | 1881801595 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 121 MEDICAL CENTER DRIVE |
| Street Address 2 Of The Provider | SUITE 2550 |
| City Of The Provider | BRUNSWICK |
| Zip Code Of The Provider | 04011 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 296 |
| Number Of Medicare Beneficiaries | 133 |
| Total Submitted Charge Amount | 101794.75 |
| Total Medicare Allowed Amount | 50599.56 |
| Total Medicare Payment Amount | 39288.07 |
| Total Medicare Standardized Payment Amount | 40273.17 |
| 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 | 61 |
| Number Of Medical Services | 296 |
| Number Of Medicare Beneficiaries With Medical Services | 133 |
| Total Medical Submitted Charge Amount | 101794.75 |
| Total Medical Medicare Allowed Amount | 50599.56 |
| Total Medical Medicare Payment Amount | 39288.07 |
| Total Medical Medicare Standardized Payment Amount | 40273.17 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 39 |
| Number Of Beneficiaries Age 75 to 84 | 44 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 81 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 93 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.35 |