| National Provider Identifier [NPI]: | 1801816079 |
| Last Name Of The Provider | MCDONALD |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2410 PAGEHURST DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MIDLOTHIAN |
| Zip Code Of The Provider | 231136411 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 753 |
| Number Of Medicare Beneficiaries | 102 |
| Total Submitted Charge Amount | 71738.4 |
| Total Medicare Allowed Amount | 49197.03 |
| Total Medicare Payment Amount | 35507.97 |
| Total Medicare Standardized Payment Amount | 36175.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 81 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 2587.4 |
| Total Drug Medicare AllowedAmount | 1884.89 |
| Total Drug Medicare PaymentAmount | 1836.14 |
| Total Drug Medicare Standardized Payment Amount | 1836.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 672 |
| Number Of Medicare Beneficiaries With Medical Services | 101 |
| Total Medical Submitted Charge Amount | 69151 |
| Total Medical Medicare Allowed Amount | 47312.14 |
| Total Medical Medicare Payment Amount | 33671.83 |
| Total Medical Medicare Standardized Payment Amount | 34339.59 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 58 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 74 |
| Number Of Male Beneficiaries | 28 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7811 |