| National Provider Identifier [NPI]: | 1780666560 |
| Last Name Of The Provider | KELLEY |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1401 BAILEY AVE |
| Street Address 2 Of The Provider | DEPT OF RADIOLOGY |
| City Of The Provider | NEEDLES |
| Zip Code Of The Provider | 923633103 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 231 |
| Number Of Services | 12382 |
| Number Of Medicare Beneficiaries | 5391 |
| Total Submitted Charge Amount | 1574154 |
| Total Medicare Allowed Amount | 397187.64 |
| Total Medicare Payment Amount | 301812.56 |
| Total Medicare Standardized Payment Amount | 305047.85 |
| 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 | 231 |
| Number Of Medical Services | 12382 |
| Number Of Medicare Beneficiaries With Medical Services | 5391 |
| Total Medical Submitted Charge Amount | 1574154 |
| Total Medical Medicare Allowed Amount | 397187.64 |
| Total Medical Medicare Payment Amount | 301812.56 |
| Total Medical Medicare Standardized Payment Amount | 305047.85 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 579 |
| Number Of Beneficiaries Age 65 to 74 | 2612 |
| Number Of Beneficiaries Age 75 to 84 | 1684 |
| Number Of Beneficiaries Age Greater 84 | 516 |
| Number Of Female Beneficiaries | 3099 |
| Number Of Male Beneficiaries | 2292 |
| Number Of Non Hispanic White Beneficiaries | 4907 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| Number Of Hispanic Beneficiaries | 292 |
| Number Of American Indian Alaska Native Beneficiaries | 59 |
| Number Of Beneficiaries With Race Not Else where Classified | 54 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4722 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 669 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2536 |