| National Provider Identifier [NPI]: | 1053361816 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1900 RIDGE RD |
| Street Address 2 Of The Provider | STE 130 |
| City Of The Provider | WEST SENECA |
| Zip Code Of The Provider | 142243332 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 849 |
| Number Of Medicare Beneficiaries | 190 |
| Total Submitted Charge Amount | 81788.61 |
| Total Medicare Allowed Amount | 66779.02 |
| Total Medicare Payment Amount | 46375.18 |
| Total Medicare Standardized Payment Amount | 46756.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 86 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 2675 |
| Total Drug Medicare AllowedAmount | 2252.41 |
| Total Drug Medicare PaymentAmount | 2060.54 |
| Total Drug Medicare Standardized Payment Amount | 2060.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 763 |
| Number Of Medicare Beneficiaries With Medical Services | 190 |
| Total Medical Submitted Charge Amount | 79113.61 |
| Total Medical Medicare Allowed Amount | 64526.61 |
| Total Medical Medicare Payment Amount | 44314.64 |
| Total Medical Medicare Standardized Payment Amount | 44696.16 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | 43 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 131 |
| 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 | 170 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2949 |