| National Provider Identifier [NPI]: | 1780619189 |
| Last Name Of The Provider | LE |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6800 ALMA DR |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | PLANO |
| Zip Code Of The Provider | 750232006 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1017 |
| Number Of Medicare Beneficiaries | 143 |
| Total Submitted Charge Amount | 87861.95 |
| Total Medicare Allowed Amount | 43427.62 |
| Total Medicare Payment Amount | 29465.61 |
| Total Medicare Standardized Payment Amount | 31732.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 67 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 3610.36 |
| Total Drug Medicare AllowedAmount | 1255.61 |
| Total Drug Medicare PaymentAmount | 1205.29 |
| Total Drug Medicare Standardized Payment Amount | 1205.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 950 |
| Number Of Medicare Beneficiaries With Medical Services | 143 |
| Total Medical Submitted Charge Amount | 84251.59 |
| Total Medical Medicare Allowed Amount | 42172.01 |
| Total Medical Medicare Payment Amount | 28260.32 |
| Total Medical Medicare Standardized Payment Amount | 30527.33 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 77 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 105 |
| Number Of Male Beneficiaries | 38 |
| Number Of Non Hispanic White Beneficiaries | 69 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 41 |
| 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 | 70 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 73 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1668 |