| National Provider Identifier [NPI]: | 1194768911 |
| Last Name Of The Provider | KELLER |
| First Name Of The Provider | SHANE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1615 GRAND AVE PKWY |
| Street Address 2 Of The Provider | SUITE 112 |
| City Of The Provider | PFLUGERVILLE |
| Zip Code Of The Provider | 786602060 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 1753 |
| Number Of Medicare Beneficiaries | 251 |
| Total Submitted Charge Amount | 160689.55 |
| Total Medicare Allowed Amount | 112572.11 |
| Total Medicare Payment Amount | 81412.68 |
| Total Medicare Standardized Payment Amount | 83934.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 365 |
| Number Of Medicare Beneficiaries With Drug Services | 135 |
| Total Drug Submitted ChargeAmount | 8254.55 |
| Total Drug Medicare AllowedAmount | 4979.99 |
| Total Drug Medicare PaymentAmount | 4667.14 |
| Total Drug Medicare Standardized Payment Amount | 4667.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 1388 |
| Number Of Medicare Beneficiaries With Medical Services | 251 |
| Total Medical Submitted Charge Amount | 152435 |
| Total Medical Medicare Allowed Amount | 107592.12 |
| Total Medical Medicare Payment Amount | 76745.54 |
| Total Medical Medicare Standardized Payment Amount | 79267.32 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 117 |
| Number Of Beneficiaries Age 75 to 84 | 60 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 147 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 210 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 227 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1443 |