| National Provider Identifier [NPI]: | 1891014569 |
| Last Name Of The Provider | DEVLIN |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1445 SHELDON RD |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | GRAND HAVEN |
| Zip Code Of The Provider | 494172480 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 560 |
| Number Of Medicare Beneficiaries | 176 |
| Total Submitted Charge Amount | 69291 |
| Total Medicare Allowed Amount | 38729.15 |
| Total Medicare Payment Amount | 29687.24 |
| Total Medicare Standardized Payment Amount | 31288.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 1893 |
| Total Drug Medicare AllowedAmount | 1041.13 |
| Total Drug Medicare PaymentAmount | 1004.92 |
| Total Drug Medicare Standardized Payment Amount | 1004.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 489 |
| Number Of Medicare Beneficiaries With Medical Services | 176 |
| Total Medical Submitted Charge Amount | 67398 |
| Total Medical Medicare Allowed Amount | 37688.02 |
| Total Medical Medicare Payment Amount | 28682.32 |
| Total Medical Medicare Standardized Payment Amount | 30283.85 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 56 |
| Number Of Beneficiaries Age 75 to 84 | 41 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 104 |
| Number Of Male Beneficiaries | 72 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 145 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0286 |