National Provider Identifier [NPI]: |
1487749693 |
Last Name Of The Provider |
KELBER |
First Name Of The Provider |
MICHAEL |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2365 GREAR ST NE |
Street Address 2 Of The Provider |
|
City Of The Provider |
SALEM |
Zip Code Of The Provider |
97301 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
45 |
Number Of Services |
559 |
Number Of Medicare Beneficiaries |
123 |
Total Submitted Charge Amount |
78377 |
Total Medicare Allowed Amount |
34529.91 |
Total Medicare Payment Amount |
23261.84 |
Total Medicare Standardized Payment Amount |
25199.68 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
12 |
Number Of Drug Services |
117 |
Number Of Medicare Beneficiaries With Drug Services |
29 |
Total Drug Submitted ChargeAmount |
2948 |
Total Drug Medicare AllowedAmount |
968.04 |
Total Drug Medicare PaymentAmount |
770.88 |
Total Drug Medicare Standardized Payment Amount |
770.88 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
33 |
Number Of Medical Services |
442 |
Number Of Medicare Beneficiaries With Medical Services |
123 |
Total Medical Submitted Charge Amount |
75429 |
Total Medical Medicare Allowed Amount |
33561.87 |
Total Medical Medicare Payment Amount |
22490.96 |
Total Medical Medicare Standardized Payment Amount |
24428.8 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
84 |
Number Of Beneficiaries Age 75 to 84 |
22 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
64 |
Number Of Male Beneficiaries |
59 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
11 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
20 |
Percent Of With Diabetes |
20 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
44 |
Percent Of With Ischemic Heart Disease |
10 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.6951 |