| National Provider Identifier [NPI]: | 1881665727 |
| Last Name Of The Provider | KELLEY |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2101 N WALDRON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | HUTCHINSON |
| Zip Code Of The Provider | 675021131 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 15938 |
| Number Of Medicare Beneficiaries | 2927 |
| Total Submitted Charge Amount | 1610595.8 |
| Total Medicare Allowed Amount | 731703.84 |
| Total Medicare Payment Amount | 519195.62 |
| Total Medicare Standardized Payment Amount | 541028.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 734 |
| Number Of Medicare Beneficiaries With Drug Services | 117 |
| Total Drug Submitted ChargeAmount | 10093 |
| Total Drug Medicare AllowedAmount | 1576.39 |
| Total Drug Medicare PaymentAmount | 1103.7 |
| Total Drug Medicare Standardized Payment Amount | 1103.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 114 |
| Number Of Medical Services | 15204 |
| Number Of Medicare Beneficiaries With Medical Services | 2927 |
| Total Medical Submitted Charge Amount | 1600502.8 |
| Total Medical Medicare Allowed Amount | 730127.45 |
| Total Medical Medicare Payment Amount | 518091.92 |
| Total Medical Medicare Standardized Payment Amount | 539924.39 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 117 |
| Number Of Beneficiaries Age 65 to 74 | 1085 |
| Number Of Beneficiaries Age 75 to 84 | 1143 |
| Number Of Beneficiaries Age Greater 84 | 582 |
| Number Of Female Beneficiaries | 1393 |
| Number Of Male Beneficiaries | 1534 |
| Number Of Non Hispanic White Beneficiaries | 2845 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2784 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 143 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9327 |