| National Provider Identifier [NPI]: | 1356329379 |
| Last Name Of The Provider | CHAVEZ |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1729 N TREKELL RD |
| Street Address 2 Of The Provider | SUITE 124 |
| City Of The Provider | CASA GRANDE |
| Zip Code Of The Provider | 85222 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 8237 |
| Number Of Medicare Beneficiaries | 908 |
| Total Submitted Charge Amount | 757357.29 |
| Total Medicare Allowed Amount | 332441.78 |
| Total Medicare Payment Amount | 227256.97 |
| Total Medicare Standardized Payment Amount | 268560.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 153 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 6544.55 |
| Total Drug Medicare AllowedAmount | 2604.12 |
| Total Drug Medicare PaymentAmount | 1860.38 |
| Total Drug Medicare Standardized Payment Amount | 1860.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 8084 |
| Number Of Medicare Beneficiaries With Medical Services | 908 |
| Total Medical Submitted Charge Amount | 750812.74 |
| Total Medical Medicare Allowed Amount | 329837.66 |
| Total Medical Medicare Payment Amount | 225396.59 |
| Total Medical Medicare Standardized Payment Amount | 266699.65 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 457 |
| Number Of Beneficiaries Age 75 to 84 | 326 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | 395 |
| Number Of Male Beneficiaries | 513 |
| Number Of Non Hispanic White Beneficiaries | 818 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | 24 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 825 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| 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 | 11 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9625 |