| National Provider Identifier [NPI]: | 1083685523 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1510 N 28TH ST |
| Street Address 2 Of The Provider | SUITE 205 |
| City Of The Provider | RICHMOND |
| Zip Code Of The Provider | 232235311 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 819 |
| Number Of Medicare Beneficiaries | 231 |
| Total Submitted Charge Amount | 193450 |
| Total Medicare Allowed Amount | 64850.89 |
| Total Medicare Payment Amount | 50117 |
| Total Medicare Standardized Payment Amount | 51076.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 819 |
| Number Of Medicare Beneficiaries With Medical Services | 231 |
| Total Medical Submitted Charge Amount | 193450 |
| Total Medical Medicare Allowed Amount | 64850.89 |
| Total Medical Medicare Payment Amount | 50117 |
| Total Medical Medicare Standardized Payment Amount | 51076.45 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 98 |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 133 |
| Number Of Male Beneficiaries | 98 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 196 |
| 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 | 92 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 139 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 29 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.2163 |