| National Provider Identifier [NPI]: | 1104838887 |
| Last Name Of The Provider | MAEDO |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2911 TEXAS AVE S |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | COLLEGE STATION |
| Zip Code Of The Provider | 778455387 |
| 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 | 49 |
| Number Of Services | 306 |
| Number Of Medicare Beneficiaries | 137 |
| Total Submitted Charge Amount | 37983.6 |
| Total Medicare Allowed Amount | 17752 |
| Total Medicare Payment Amount | 12943.23 |
| Total Medicare Standardized Payment Amount | 13843.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 62 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1157.6 |
| Total Drug Medicare AllowedAmount | 181 |
| Total Drug Medicare PaymentAmount | 118.92 |
| Total Drug Medicare Standardized Payment Amount | 118.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 244 |
| Number Of Medicare Beneficiaries With Medical Services | 136 |
| Total Medical Submitted Charge Amount | 36826 |
| Total Medical Medicare Allowed Amount | 17571 |
| Total Medical Medicare Payment Amount | 12824.31 |
| Total Medical Medicare Standardized Payment Amount | 13724.59 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 88 |
| Number Of Male Beneficiaries | 49 |
| Number Of Non Hispanic White Beneficiaries | 110 |
| Number Of Black or African American Beneficiaries | 13 |
| 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 | 113 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0152 |