| National Provider Identifier [NPI]: | 1205814191 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19020 33RD AVE W |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | LYNNWOOD |
| Zip Code Of The Provider | 980364746 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 1671 |
| Number Of Medicare Beneficiaries | 725 |
| Total Submitted Charge Amount | 113030.6 |
| Total Medicare Allowed Amount | 45705.8 |
| Total Medicare Payment Amount | 39809.98 |
| Total Medicare Standardized Payment Amount | 38108.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 1671 |
| Number Of Medicare Beneficiaries With Medical Services | 725 |
| Total Medical Submitted Charge Amount | 113030.6 |
| Total Medical Medicare Allowed Amount | 45705.8 |
| Total Medical Medicare Payment Amount | 39809.98 |
| Total Medical Medicare Standardized Payment Amount | 38108.4 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 433 |
| Number Of Beneficiaries Age 75 to 84 | 190 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | 527 |
| Number Of Black or African American Beneficiaries | 60 |
| Number Of AsianPacific Islander Beneficiaries | 108 |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 602 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 123 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 3 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 11 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7476 |