| National Provider Identifier [NPI]: | 1417942400 |
| Last Name Of The Provider | DONNELLY |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 222 S WOODS MILL RD |
| Street Address 2 Of The Provider | SUITE 710N |
| City Of The Provider | CHESTERFIELD |
| Zip Code Of The Provider | 630173625 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 19847 |
| Number Of Medicare Beneficiaries | 2279 |
| Total Submitted Charge Amount | 1122338.32 |
| Total Medicare Allowed Amount | 890664.06 |
| Total Medicare Payment Amount | 660518.05 |
| Total Medicare Standardized Payment Amount | 685226.27 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 992 |
| Number Of Beneficiaries Age 75 to 84 | 863 |
| Number Of Beneficiaries Age Greater 84 | 365 |
| Number Of Female Beneficiaries | 1017 |
| Number Of Male Beneficiaries | 1262 |
| Number Of Non Hispanic White Beneficiaries | 2207 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | |
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| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2240 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9707 |