| National Provider Identifier [NPI]: | 1598738197 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5100 GAMBLE DR SUITE 100 - MAIL STOP 31200A |
| Street Address 2 Of The Provider | HEALTHPARTNERS WEST CLINIC |
| City Of The Provider | ST. LOUIS PARK |
| Zip Code Of The Provider | 554161582 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 428 |
| Number Of Medicare Beneficiaries | 107 |
| Total Submitted Charge Amount | 52266 |
| Total Medicare Allowed Amount | 19134.86 |
| Total Medicare Payment Amount | 12724.28 |
| Total Medicare Standardized Payment Amount | 13933.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 39 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 1201 |
| Total Drug Medicare AllowedAmount | 894.39 |
| Total Drug Medicare PaymentAmount | 849.66 |
| Total Drug Medicare Standardized Payment Amount | 849.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 389 |
| Number Of Medicare Beneficiaries With Medical Services | 107 |
| Total Medical Submitted Charge Amount | 51065 |
| Total Medical Medicare Allowed Amount | 18240.47 |
| Total Medical Medicare Payment Amount | 11874.62 |
| Total Medical Medicare Standardized Payment Amount | 13083.44 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 54 |
| Number Of Male Beneficiaries | 53 |
| Number Of Non Hispanic White Beneficiaries | 86 |
| 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 | 76 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 26 |
| Percent Of With Hypertension | 37 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 18 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8751 |