| National Provider Identifier [NPI]: | 1700991320 |
| Last Name Of The Provider | KELTY |
| First Name Of The Provider | GERALD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6130 TRIER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468155339 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 889 |
| Number Of Medicare Beneficiaries | 269 |
| Total Submitted Charge Amount | 110054 |
| Total Medicare Allowed Amount | 60029.29 |
| Total Medicare Payment Amount | 39878.93 |
| Total Medicare Standardized Payment Amount | 42565.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 154 |
| Number Of Medicare Beneficiaries With Drug Services | 102 |
| Total Drug Submitted ChargeAmount | 16594 |
| Total Drug Medicare AllowedAmount | 7667.95 |
| Total Drug Medicare PaymentAmount | 7476.63 |
| Total Drug Medicare Standardized Payment Amount | 7476.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 735 |
| Number Of Medicare Beneficiaries With Medical Services | 269 |
| Total Medical Submitted Charge Amount | 93460 |
| Total Medical Medicare Allowed Amount | 52361.34 |
| Total Medical Medicare Payment Amount | 32402.3 |
| Total Medical Medicare Standardized Payment Amount | 35089.15 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 115 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 119 |
| Number Of Non Hispanic White Beneficiaries | 254 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 227 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9715 |