| National Provider Identifier [NPI]: | 1063402972 |
| Last Name Of The Provider | MYRICK |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6400 DUTCHMANS PKWY |
| Street Address 2 Of The Provider | SUITE 215 |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402053340 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 101 |
| Number Of Services | 835 |
| Number Of Medicare Beneficiaries | 137 |
| Total Submitted Charge Amount | 329952 |
| Total Medicare Allowed Amount | 117123.71 |
| Total Medicare Payment Amount | 89351.46 |
| Total Medicare Standardized Payment Amount | 97593.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 200 |
| Total Drug Medicare AllowedAmount | 35.49 |
| Total Drug Medicare PaymentAmount | 27.82 |
| Total Drug Medicare Standardized Payment Amount | 27.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 815 |
| Number Of Medicare Beneficiaries With Medical Services | 137 |
| Total Medical Submitted Charge Amount | 329752 |
| Total Medical Medicare Allowed Amount | 117088.22 |
| Total Medical Medicare Payment Amount | 89323.64 |
| Total Medical Medicare Standardized Payment Amount | 97565.81 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 54 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 101 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 111 |
| 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 | 102 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 35 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2615 |