| National Provider Identifier [NPI]: | 1508836032 |
| Last Name Of The Provider | KELLUM |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1542 MEDICAL PARK CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUPELO |
| Zip Code Of The Provider | 388016560 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 7312 |
| Number Of Medicare Beneficiaries | 1003 |
| Total Submitted Charge Amount | 1289015 |
| Total Medicare Allowed Amount | 417277.32 |
| Total Medicare Payment Amount | 322352.17 |
| Total Medicare Standardized Payment Amount | 341841.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1673 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 12045 |
| Total Drug Medicare AllowedAmount | 6406.6 |
| Total Drug Medicare PaymentAmount | 4879.2 |
| Total Drug Medicare Standardized Payment Amount | 4879.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 5639 |
| Number Of Medicare Beneficiaries With Medical Services | 1003 |
| Total Medical Submitted Charge Amount | 1276970 |
| Total Medical Medicare Allowed Amount | 410870.72 |
| Total Medical Medicare Payment Amount | 317472.97 |
| Total Medical Medicare Standardized Payment Amount | 336962.02 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 332 |
| Number Of Beneficiaries Age 65 to 74 | 361 |
| Number Of Beneficiaries Age 75 to 84 | 231 |
| Number Of Beneficiaries Age Greater 84 | 79 |
| Number Of Female Beneficiaries | 508 |
| Number Of Male Beneficiaries | 495 |
| Number Of Non Hispanic White Beneficiaries | 656 |
| Number Of Black or African American Beneficiaries | 334 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 519 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 484 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 54 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 64 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 4.0684 |