| National Provider Identifier [NPI]: | 1790712883 |
| Last Name Of The Provider | MAXWELL |
| First Name Of The Provider | KEEGAN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2351 CONNECTICUT AVE S |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | SARTELL |
| Zip Code Of The Provider | 563772477 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 4046 |
| Number Of Medicare Beneficiaries | 438 |
| Total Submitted Charge Amount | 437157 |
| Total Medicare Allowed Amount | 150452.85 |
| Total Medicare Payment Amount | 110928.04 |
| Total Medicare Standardized Payment Amount | 113129.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 2450 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 88281 |
| Total Drug Medicare AllowedAmount | 31809.5 |
| Total Drug Medicare PaymentAmount | 24771.13 |
| Total Drug Medicare Standardized Payment Amount | 24771.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 1596 |
| Number Of Medicare Beneficiaries With Medical Services | 438 |
| Total Medical Submitted Charge Amount | 348876 |
| Total Medical Medicare Allowed Amount | 118643.35 |
| Total Medical Medicare Payment Amount | 86156.91 |
| Total Medical Medicare Standardized Payment Amount | 88358.43 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 137 |
| Number Of Beneficiaries Age 75 to 84 | 160 |
| Number Of Beneficiaries Age Greater 84 | 58 |
| Number Of Female Beneficiaries | 107 |
| Number Of Male Beneficiaries | 331 |
| Number Of Non Hispanic White Beneficiaries | 423 |
| Number Of Black or African American Beneficiaries | |
| 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 | 350 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 88 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 24 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2407 |