| National Provider Identifier [NPI]: | 1114911492 |
| Last Name Of The Provider | O'DONNELL |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 77 WEST FOREST AVENUE |
| Street Address 2 Of The Provider | SUITE 301 |
| City Of The Provider | FLAGSTAFF |
| Zip Code Of The Provider | 86001 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 5005 |
| Number Of Medicare Beneficiaries | 350 |
| Total Submitted Charge Amount | 569016.55 |
| Total Medicare Allowed Amount | 165995.13 |
| Total Medicare Payment Amount | 121025.26 |
| Total Medicare Standardized Payment Amount | 120484.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 2643 |
| Number Of Medicare Beneficiaries With Drug Services | 203 |
| Total Drug Submitted ChargeAmount | 76454.54 |
| Total Drug Medicare AllowedAmount | 13952.14 |
| Total Drug Medicare PaymentAmount | 10840.22 |
| Total Drug Medicare Standardized Payment Amount | 10840.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 2362 |
| Number Of Medicare Beneficiaries With Medical Services | 350 |
| Total Medical Submitted Charge Amount | 492562.01 |
| Total Medical Medicare Allowed Amount | 152042.99 |
| Total Medical Medicare Payment Amount | 110185.04 |
| Total Medical Medicare Standardized Payment Amount | 109644.15 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 214 |
| Number Of Beneficiaries Age 75 to 84 | 79 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 213 |
| Number Of Male Beneficiaries | 137 |
| Number Of Non Hispanic White Beneficiaries | 308 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 318 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 74 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8885 |