| National Provider Identifier [NPI]: | 1972898807 |
| Last Name Of The Provider | KLEINSCHMIDT |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | RN, CNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4212 GRAND AVE |
| Street Address 2 Of The Provider | ESSENTIA HEALTH WEST DULUTH CLINIC |
| City Of The Provider | DULUTH |
| Zip Code Of The Provider | 558072737 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 261 |
| Number Of Medicare Beneficiaries | 175 |
| Total Submitted Charge Amount | 18761 |
| Total Medicare Allowed Amount | 13596.59 |
| Total Medicare Payment Amount | 9133.77 |
| Total Medicare Standardized Payment Amount | 11427.96 |
| 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 | 14 |
| Number Of Medical Services | 261 |
| Number Of Medicare Beneficiaries With Medical Services | 175 |
| Total Medical Submitted Charge Amount | 18761 |
| Total Medical Medicare Allowed Amount | 13596.59 |
| Total Medical Medicare Payment Amount | 9133.77 |
| Total Medical Medicare Standardized Payment Amount | 11427.96 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 39 |
| Number Of Beneficiaries Age 75 to 84 | 19 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 56 |
| Number Of Non Hispanic White Beneficiaries | 161 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 70 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 105 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 25 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 28 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2568 |