| National Provider Identifier [NPI]: | 1578518817 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | RALPH |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2205 JOLLY RD |
| Street Address 2 Of The Provider | STE B |
| City Of The Provider | OKEMOS |
| Zip Code Of The Provider | 488643983 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 6454 |
| Number Of Medicare Beneficiaries | 490 |
| Total Submitted Charge Amount | 443607.98 |
| Total Medicare Allowed Amount | 370438.13 |
| Total Medicare Payment Amount | 279559.03 |
| Total Medicare Standardized Payment Amount | 289261.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 546 |
| Number Of Medicare Beneficiaries With Drug Services | 244 |
| Total Drug Submitted ChargeAmount | 6319.26 |
| Total Drug Medicare AllowedAmount | 4702.2 |
| Total Drug Medicare PaymentAmount | 4385.09 |
| Total Drug Medicare Standardized Payment Amount | 4385.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 5908 |
| Number Of Medicare Beneficiaries With Medical Services | 490 |
| Total Medical Submitted Charge Amount | 437288.72 |
| Total Medical Medicare Allowed Amount | 365735.93 |
| Total Medical Medicare Payment Amount | 275173.94 |
| Total Medical Medicare Standardized Payment Amount | 284876.64 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 104 |
| Number Of Beneficiaries Age 65 to 74 | 81 |
| Number Of Beneficiaries Age 75 to 84 | 115 |
| Number Of Beneficiaries Age Greater 84 | 190 |
| Number Of Female Beneficiaries | 318 |
| Number Of Male Beneficiaries | 172 |
| Number Of Non Hispanic White Beneficiaries | 426 |
| Number Of Black or African American Beneficiaries | 46 |
| 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 | 288 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 202 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 72 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 75 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 47 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 75 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 66 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.4244 |