| National Provider Identifier [NPI]: | 1679844104 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | THERESA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 28455 HAGGERTY RD |
| Street Address 2 Of The Provider | STE 200 |
| City Of The Provider | NOVI |
| Zip Code Of The Provider | 483772982 |
| 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 | 8 |
| Number Of Services | 761 |
| Number Of Medicare Beneficiaries | 548 |
| Total Submitted Charge Amount | 101375 |
| Total Medicare Allowed Amount | 49848.55 |
| Total Medicare Payment Amount | 38565.34 |
| Total Medicare Standardized Payment Amount | 44453.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 8 |
| Number Of Medical Services | 761 |
| Number Of Medicare Beneficiaries With Medical Services | 548 |
| Total Medical Submitted Charge Amount | 101375 |
| Total Medical Medicare Allowed Amount | 49848.55 |
| Total Medical Medicare Payment Amount | 38565.34 |
| Total Medical Medicare Standardized Payment Amount | 44453.71 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 121 |
| Number Of Beneficiaries Age 75 to 84 | 167 |
| Number Of Beneficiaries Age Greater 84 | 203 |
| Number Of Female Beneficiaries | 344 |
| Number Of Male Beneficiaries | 204 |
| Number Of Non Hispanic White Beneficiaries | 368 |
| Number Of Black or African American Beneficiaries | 165 |
| 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 | 390 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 158 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 57 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 64 |
| Percent Of With Chronic Kidney Disease | 63 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 48 |
| Percent Of With Depression | 55 |
| Percent Of With Diabetes | 60 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 74 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 22 |
| Average HCC Risk Score Of Beneficiaries | 2.9359 |