| National Provider Identifier [NPI]: | 1255441143 |
| Last Name Of The Provider | TRACEY |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 40232 JUNCTION DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | OAKHURST |
| Zip Code Of The Provider | 936448719 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 461 |
| Number Of Medicare Beneficiaries | 168 |
| Total Submitted Charge Amount | 42866.01 |
| Total Medicare Allowed Amount | 29165.23 |
| Total Medicare Payment Amount | 22600.71 |
| Total Medicare Standardized Payment Amount | 22372.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 38 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 2893 |
| Total Drug Medicare AllowedAmount | 1941.49 |
| Total Drug Medicare PaymentAmount | 1896.16 |
| Total Drug Medicare Standardized Payment Amount | 1896.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 423 |
| Number Of Medicare Beneficiaries With Medical Services | 168 |
| Total Medical Submitted Charge Amount | 39973.01 |
| Total Medical Medicare Allowed Amount | 27223.74 |
| Total Medical Medicare Payment Amount | 20704.55 |
| Total Medical Medicare Standardized Payment Amount | 20476.38 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 92 |
| Number Of Beneficiaries Age 75 to 84 | 40 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 110 |
| Number Of Male Beneficiaries | 58 |
| Number Of Non Hispanic White Beneficiaries | 155 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8015 |