| National Provider Identifier [NPI]: | 1285638965 |
| Last Name Of The Provider | KELLER |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1325 SAN MARCO BLVD STE 200 |
| Street Address 2 Of The Provider | CREDENTIALING DEPARTMENT |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322078566 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 112 |
| Number Of Services | 2950 |
| Number Of Medicare Beneficiaries | 563 |
| Total Submitted Charge Amount | 1248753.04 |
| Total Medicare Allowed Amount | 409913.45 |
| Total Medicare Payment Amount | 310474.39 |
| Total Medicare Standardized Payment Amount | 307940.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 581 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 10836.04 |
| Total Drug Medicare AllowedAmount | 6469.57 |
| Total Drug Medicare PaymentAmount | 5057.99 |
| Total Drug Medicare Standardized Payment Amount | 5057.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 108 |
| Number Of Medical Services | 2369 |
| Number Of Medicare Beneficiaries With Medical Services | 563 |
| Total Medical Submitted Charge Amount | 1237917 |
| Total Medical Medicare Allowed Amount | 403443.88 |
| Total Medical Medicare Payment Amount | 305416.4 |
| Total Medical Medicare Standardized Payment Amount | 302882.13 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 251 |
| Number Of Beneficiaries Age 75 to 84 | 176 |
| Number Of Beneficiaries Age Greater 84 | 62 |
| Number Of Female Beneficiaries | 347 |
| Number Of Male Beneficiaries | 216 |
| Number Of Non Hispanic White Beneficiaries | 497 |
| Number Of Black or African American Beneficiaries | 48 |
| 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 | 506 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3519 |