| National Provider Identifier [NPI]: | 1700989605 |
| Last Name Of The Provider | SHIVELY |
| First Name Of The Provider | KIRSTEN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1550 3 MILE RD NW |
| Street Address 2 Of The Provider | |
| City Of The Provider | WALKER |
| Zip Code Of The Provider | 495448251 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 274 |
| Number Of Medicare Beneficiaries | 118 |
| Total Submitted Charge Amount | 26134 |
| Total Medicare Allowed Amount | 9624.53 |
| Total Medicare Payment Amount | 6777.53 |
| Total Medicare Standardized Payment Amount | 8430.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 81 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 146 |
| Total Drug Medicare AllowedAmount | 45.44 |
| Total Drug Medicare PaymentAmount | 33.69 |
| Total Drug Medicare Standardized Payment Amount | 33.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 193 |
| Number Of Medicare Beneficiaries With Medical Services | 118 |
| Total Medical Submitted Charge Amount | 25988 |
| Total Medical Medicare Allowed Amount | 9579.09 |
| Total Medical Medicare Payment Amount | 6743.84 |
| Total Medical Medicare Standardized Payment Amount | 8396.76 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | 28 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 82 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 92 |
| 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 | 61 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.912 |