| National Provider Identifier [NPI]: | 1316985989 |
| Last Name Of The Provider | KENNEDY |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3126 S JACKSON AVE |
| Street Address 2 Of The Provider | STE 101 |
| City Of The Provider | JOPLIN |
| Zip Code Of The Provider | 648042534 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 13711 |
| Number Of Medicare Beneficiaries | 3370 |
| Total Submitted Charge Amount | 573877 |
| Total Medicare Allowed Amount | 270893.57 |
| Total Medicare Payment Amount | 200678.48 |
| Total Medicare Standardized Payment Amount | 220739.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 1710 |
| Number Of Medicare Beneficiaries With Drug Services | 237 |
| Total Drug Submitted ChargeAmount | 18481 |
| Total Drug Medicare AllowedAmount | 9227.06 |
| Total Drug Medicare PaymentAmount | 7613.31 |
| Total Drug Medicare Standardized Payment Amount | 7613.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 116 |
| Number Of Medical Services | 12001 |
| Number Of Medicare Beneficiaries With Medical Services | 3370 |
| Total Medical Submitted Charge Amount | 555396 |
| Total Medical Medicare Allowed Amount | 261666.51 |
| Total Medical Medicare Payment Amount | 193065.17 |
| Total Medical Medicare Standardized Payment Amount | 213125.98 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 560 |
| Number Of Beneficiaries Age 65 to 74 | 1284 |
| Number Of Beneficiaries Age 75 to 84 | 1077 |
| Number Of Beneficiaries Age Greater 84 | 449 |
| Number Of Female Beneficiaries | 1937 |
| Number Of Male Beneficiaries | 1433 |
| Number Of Non Hispanic White Beneficiaries | 3203 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | 49 |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2804 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 566 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1697 |