| National Provider Identifier [NPI]: | 1073597514 |
| Last Name Of The Provider | ANDRESEN |
| First Name Of The Provider | KELLI |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4401 WORNALL RD |
| Street Address 2 Of The Provider | RADIOLOGY DEPT |
| City Of The Provider | KANSAS CITY |
| Zip Code Of The Provider | 641113220 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 6095 |
| Number Of Medicare Beneficiaries | 3353 |
| Total Submitted Charge Amount | 769481 |
| Total Medicare Allowed Amount | 208093.56 |
| Total Medicare Payment Amount | 154586.94 |
| Total Medicare Standardized Payment Amount | 155971.19 |
| 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 | 150 |
| Number Of Medical Services | 6095 |
| Number Of Medicare Beneficiaries With Medical Services | 3353 |
| Total Medical Submitted Charge Amount | 769481 |
| Total Medical Medicare Allowed Amount | 208093.56 |
| Total Medical Medicare Payment Amount | 154586.94 |
| Total Medical Medicare Standardized Payment Amount | 155971.19 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 704 |
| Number Of Beneficiaries Age 65 to 74 | 1093 |
| Number Of Beneficiaries Age 75 to 84 | 937 |
| Number Of Beneficiaries Age Greater 84 | 619 |
| Number Of Female Beneficiaries | 1856 |
| Number Of Male Beneficiaries | 1497 |
| Number Of Non Hispanic White Beneficiaries | 2698 |
| Number Of Black or African American Beneficiaries | 526 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 81 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2596 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 757 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.1188 |