| National Provider Identifier [NPI]: | 1083608244 |
| Last Name Of The Provider | TOLER |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | PA C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2400 BELLEVUE RD |
| Street Address 2 Of The Provider | 16 ERIN OFC PARK |
| City Of The Provider | DUBLIN |
| Zip Code Of The Provider | 310212885 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 7012 |
| Number Of Medicare Beneficiaries | 1429 |
| Total Submitted Charge Amount | 433512.23 |
| Total Medicare Allowed Amount | 416025.97 |
| Total Medicare Payment Amount | 296990.25 |
| Total Medicare Standardized Payment Amount | 373787.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 50 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 3798.59 |
| Total Drug Medicare AllowedAmount | 3777.86 |
| Total Drug Medicare PaymentAmount | 2959.02 |
| Total Drug Medicare Standardized Payment Amount | 2959.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 6962 |
| Number Of Medicare Beneficiaries With Medical Services | 1429 |
| Total Medical Submitted Charge Amount | 429713.64 |
| Total Medical Medicare Allowed Amount | 412248.11 |
| Total Medical Medicare Payment Amount | 294031.23 |
| Total Medical Medicare Standardized Payment Amount | 370828.01 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 603 |
| Number Of Beneficiaries Age 75 to 84 | 487 |
| Number Of Beneficiaries Age Greater 84 | 168 |
| Number Of Female Beneficiaries | 788 |
| Number Of Male Beneficiaries | 641 |
| Number Of Non Hispanic White Beneficiaries | 1341 |
| Number Of Black or African American Beneficiaries | 73 |
| 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 | 1140 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 289 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1298 |