| National Provider Identifier [NPI]: | 1417952185 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 50 MEDICAL PARK DR E |
| Street Address 2 Of The Provider | |
| City Of The Provider | BIRMINGHAM |
| Zip Code Of The Provider | 352353401 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 187 |
| Number Of Services | 11566 |
| Number Of Medicare Beneficiaries | 4005 |
| Total Submitted Charge Amount | 1047932.5 |
| Total Medicare Allowed Amount | 253126.09 |
| Total Medicare Payment Amount | 199328.16 |
| Total Medicare Standardized Payment Amount | 218406.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 5139 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 5251.5 |
| Total Drug Medicare AllowedAmount | 1390.06 |
| Total Drug Medicare PaymentAmount | 1089.91 |
| Total Drug Medicare Standardized Payment Amount | 1089.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 184 |
| Number Of Medical Services | 6427 |
| Number Of Medicare Beneficiaries With Medical Services | 4005 |
| Total Medical Submitted Charge Amount | 1042681 |
| Total Medical Medicare Allowed Amount | 251736.03 |
| Total Medical Medicare Payment Amount | 198238.25 |
| Total Medical Medicare Standardized Payment Amount | 217316.52 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 777 |
| Number Of Beneficiaries Age 65 to 74 | 1364 |
| Number Of Beneficiaries Age 75 to 84 | 1214 |
| Number Of Beneficiaries Age Greater 84 | 650 |
| Number Of Female Beneficiaries | 2432 |
| Number Of Male Beneficiaries | 1573 |
| Number Of Non Hispanic White Beneficiaries | 3647 |
| Number Of Black or African American Beneficiaries | 323 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3064 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 941 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6255 |