| National Provider Identifier [NPI]: | 1770515926 |
| Last Name Of The Provider | HAMBLIN |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2751 W 9000 S |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST JORDAN |
| Zip Code Of The Provider | 84088 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 742 |
| Number Of Medicare Beneficiaries | 138 |
| Total Submitted Charge Amount | 126456 |
| Total Medicare Allowed Amount | 53251.61 |
| Total Medicare Payment Amount | 38570.19 |
| Total Medicare Standardized Payment Amount | 40731.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 69 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 679 |
| Total Drug Medicare AllowedAmount | 185.45 |
| Total Drug Medicare PaymentAmount | 145.34 |
| Total Drug Medicare Standardized Payment Amount | 145.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 673 |
| Number Of Medicare Beneficiaries With Medical Services | 138 |
| Total Medical Submitted Charge Amount | 125777 |
| Total Medical Medicare Allowed Amount | 53066.16 |
| Total Medical Medicare Payment Amount | 38424.85 |
| Total Medical Medicare Standardized Payment Amount | 40586.42 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 65 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 81 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 126 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1326 |