| National Provider Identifier [NPI]: | 1700849544 |
| Last Name Of The Provider | HENDERSHOT |
| First Name Of The Provider | KERRY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7601 QUAKER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LUBBOCK |
| Zip Code Of The Provider | 79424 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 159 |
| Number Of Services | 6579 |
| Number Of Medicare Beneficiaries | 659 |
| Total Submitted Charge Amount | 512030.28 |
| Total Medicare Allowed Amount | 223245.35 |
| Total Medicare Payment Amount | 165651.99 |
| Total Medicare Standardized Payment Amount | 178330.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 23 |
| Number Of Drug Services | 819 |
| Number Of Medicare Beneficiaries With Drug Services | 230 |
| Total Drug Submitted ChargeAmount | 34361 |
| Total Drug Medicare AllowedAmount | 13552.03 |
| Total Drug Medicare PaymentAmount | 12600.09 |
| Total Drug Medicare Standardized Payment Amount | 12600.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 136 |
| Number Of Medical Services | 5760 |
| Number Of Medicare Beneficiaries With Medical Services | 659 |
| Total Medical Submitted Charge Amount | 477669.28 |
| Total Medical Medicare Allowed Amount | 209693.32 |
| Total Medical Medicare Payment Amount | 153051.9 |
| Total Medical Medicare Standardized Payment Amount | 165730.66 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 261 |
| Number Of Beneficiaries Age 75 to 84 | 228 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 386 |
| Number Of Male Beneficiaries | 273 |
| Number Of Non Hispanic White Beneficiaries | 580 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 60 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 585 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 74 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.09 |