| National Provider Identifier [NPI]: | 1083055396 |
| Last Name Of The Provider | KELLEY |
| First Name Of The Provider | PHILLIP |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 600 HIGHLAND OAKS DR |
| Street Address 2 Of The Provider | APT H |
| City Of The Provider | WINSTON SALEM |
| Zip Code Of The Provider | 271037107 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 286 |
| Number Of Medicare Beneficiaries | 149 |
| Total Submitted Charge Amount | 33610 |
| Total Medicare Allowed Amount | 15003.02 |
| Total Medicare Payment Amount | 9727.67 |
| Total Medicare Standardized Payment Amount | 12242.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 528 |
| Total Drug Medicare AllowedAmount | 49.64 |
| Total Drug Medicare PaymentAmount | 41.68 |
| Total Drug Medicare Standardized Payment Amount | 41.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 260 |
| Number Of Medicare Beneficiaries With Medical Services | 149 |
| Total Medical Submitted Charge Amount | 33082 |
| Total Medical Medicare Allowed Amount | 14953.38 |
| Total Medical Medicare Payment Amount | 9685.99 |
| Total Medical Medicare Standardized Payment Amount | 12200.64 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | 40 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 90 |
| Number Of Male Beneficiaries | 59 |
| Number Of Non Hispanic White Beneficiaries | 123 |
| 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 | 118 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1109 |