| National Provider Identifier [NPI]: | 1831195528 |
| Last Name Of The Provider | MCDONOUGH |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2601 KELLEY POINTE PKWY |
| Street Address 2 Of The Provider | STE 101 |
| City Of The Provider | EDMOND |
| Zip Code Of The Provider | 730132996 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 2555 |
| Number Of Medicare Beneficiaries | 958 |
| Total Submitted Charge Amount | 296132 |
| Total Medicare Allowed Amount | 112803.41 |
| Total Medicare Payment Amount | 92162.37 |
| Total Medicare Standardized Payment Amount | 103272.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 400 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1241 |
| Total Drug Medicare AllowedAmount | 785 |
| Total Drug Medicare PaymentAmount | 615.52 |
| Total Drug Medicare Standardized Payment Amount | 615.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 2155 |
| Number Of Medicare Beneficiaries With Medical Services | 958 |
| Total Medical Submitted Charge Amount | 294891 |
| Total Medical Medicare Allowed Amount | 112018.41 |
| Total Medical Medicare Payment Amount | 91546.85 |
| Total Medical Medicare Standardized Payment Amount | 102657.07 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 607 |
| Number Of Beneficiaries Age 75 to 84 | 260 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | 897 |
| Number Of Black or African American Beneficiaries | 31 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 927 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.7167 |