| National Provider Identifier [NPI]: | 1063430213 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | LATONYA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3921 I 49 S SERVICE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | OPELOUSAS |
| Zip Code Of The Provider | 705700758 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 2492 |
| Number Of Medicare Beneficiaries | 349 |
| Total Submitted Charge Amount | 148953 |
| Total Medicare Allowed Amount | 117886.86 |
| Total Medicare Payment Amount | 84718.59 |
| Total Medicare Standardized Payment Amount | 89745.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 123 |
| Number Of Medicare Beneficiaries With Drug Services | 110 |
| Total Drug Submitted ChargeAmount | 4924 |
| Total Drug Medicare AllowedAmount | 3571.97 |
| Total Drug Medicare PaymentAmount | 3491.01 |
| Total Drug Medicare Standardized Payment Amount | 3491.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 2369 |
| Number Of Medicare Beneficiaries With Medical Services | 349 |
| Total Medical Submitted Charge Amount | 144029 |
| Total Medical Medicare Allowed Amount | 114314.89 |
| Total Medical Medicare Payment Amount | 81227.58 |
| Total Medical Medicare Standardized Payment Amount | 86254.98 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 161 |
| Number Of Beneficiaries Age 75 to 84 | 99 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 265 |
| Number Of Male Beneficiaries | 84 |
| Number Of Non Hispanic White Beneficiaries | 219 |
| 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 | 206 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 143 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2767 |