| National Provider Identifier [NPI]: | 1518072800 |
| Last Name Of The Provider | KELLERMEYER |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 736 BATTLEFIELD BLVD N |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHESAPEAKE |
| Zip Code Of The Provider | 233204941 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 171 |
| Number Of Services | 8335 |
| Number Of Medicare Beneficiaries | 4793 |
| Total Submitted Charge Amount | 960845 |
| Total Medicare Allowed Amount | 222115.42 |
| Total Medicare Payment Amount | 177616.06 |
| Total Medicare Standardized Payment Amount | 185559.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 171 |
| Number Of Medical Services | 8335 |
| Number Of Medicare Beneficiaries With Medical Services | 4793 |
| Total Medical Submitted Charge Amount | 960845 |
| Total Medical Medicare Allowed Amount | 222115.42 |
| Total Medical Medicare Payment Amount | 177616.06 |
| Total Medical Medicare Standardized Payment Amount | 185559.83 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 805 |
| Number Of Beneficiaries Age 65 to 74 | 2193 |
| Number Of Beneficiaries Age 75 to 84 | 1305 |
| Number Of Beneficiaries Age Greater 84 | 490 |
| Number Of Female Beneficiaries | 3492 |
| Number Of Male Beneficiaries | 1301 |
| Number Of Non Hispanic White Beneficiaries | 4431 |
| Number Of Black or African American Beneficiaries | 185 |
| Number Of AsianPacific Islander Beneficiaries | 35 |
| Number Of Hispanic Beneficiaries | 116 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3680 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1113 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.3901 |