| National Provider Identifier [NPI]: | 1326153941 |
| Last Name Of The Provider | KELTY |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3909 NEW VISION DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468451725 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 1086 |
| Number Of Medicare Beneficiaries | 298 |
| Total Submitted Charge Amount | 124227 |
| Total Medicare Allowed Amount | 67430.88 |
| Total Medicare Payment Amount | 44036.33 |
| Total Medicare Standardized Payment Amount | 47434.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 160 |
| Number Of Medicare Beneficiaries With Drug Services | 116 |
| Total Drug Submitted ChargeAmount | 13048 |
| Total Drug Medicare AllowedAmount | 5369.01 |
| Total Drug Medicare PaymentAmount | 5197.62 |
| Total Drug Medicare Standardized Payment Amount | 5197.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 926 |
| Number Of Medicare Beneficiaries With Medical Services | 298 |
| Total Medical Submitted Charge Amount | 111179 |
| Total Medical Medicare Allowed Amount | 62061.87 |
| Total Medical Medicare Payment Amount | 38838.71 |
| Total Medical Medicare Standardized Payment Amount | 42236.74 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 133 |
| Number Of Beneficiaries Age 75 to 84 | 68 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 138 |
| Number Of Non Hispanic White Beneficiaries | 284 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 278 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| 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 | 17 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9888 |