| National Provider Identifier [NPI]: | 1477644227 |
| Last Name Of The Provider | SEBESTYEN |
| First Name Of The Provider | KELLI |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2442 WINNE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HELENA |
| Zip Code Of The Provider | 596014913 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 2324 |
| Number Of Medicare Beneficiaries | 171 |
| Total Submitted Charge Amount | 345750 |
| Total Medicare Allowed Amount | 87098.37 |
| Total Medicare Payment Amount | 64787.14 |
| Total Medicare Standardized Payment Amount | 67574.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1543 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 98143 |
| Total Drug Medicare AllowedAmount | 42595.3 |
| Total Drug Medicare PaymentAmount | 32706.65 |
| Total Drug Medicare Standardized Payment Amount | 32706.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 781 |
| Number Of Medicare Beneficiaries With Medical Services | 171 |
| Total Medical Submitted Charge Amount | 247607 |
| Total Medical Medicare Allowed Amount | 44503.07 |
| Total Medical Medicare Payment Amount | 32080.49 |
| Total Medical Medicare Standardized Payment Amount | 34868.01 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 90 |
| Number Of Beneficiaries Age 75 to 84 | 40 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 93 |
| Number Of Male Beneficiaries | 78 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 150 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 33 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8738 |