| National Provider Identifier [NPI]: | 1144220070 |
| Last Name Of The Provider | SCHULTZ |
| First Name Of The Provider | KELLI |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 240 N BLUFF BLVD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | CLINTON |
| Zip Code Of The Provider | 527327160 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 239 |
| Number Of Medicare Beneficiaries | 40 |
| Total Submitted Charge Amount | 30265 |
| Total Medicare Allowed Amount | 14613.62 |
| Total Medicare Payment Amount | 10219.83 |
| Total Medicare Standardized Payment Amount | 13215.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 338 |
| Total Drug Medicare AllowedAmount | 199.76 |
| Total Drug Medicare PaymentAmount | 195.74 |
| Total Drug Medicare Standardized Payment Amount | 195.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 226 |
| Number Of Medicare Beneficiaries With Medical Services | 40 |
| Total Medical Submitted Charge Amount | 29927 |
| Total Medical Medicare Allowed Amount | 14413.86 |
| Total Medical Medicare Payment Amount | 10024.09 |
| Total Medical Medicare Standardized Payment Amount | 13019.35 |
| Average Age Of Beneficiaries | 50 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 29 |
| Number Of Male Beneficiaries | 11 |
| 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 | 0 |
| Percent Of With Asthma | 28 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.9724 |