| National Provider Identifier [NPI]: | 1003169285 |
| Last Name Of The Provider | HUPP |
| First Name Of The Provider | KELSEY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 335 FAIRVIEW ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SILVERTON |
| Zip Code Of The Provider | 973811916 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 332 |
| Number Of Medicare Beneficiaries | 81 |
| Total Submitted Charge Amount | 36757 |
| Total Medicare Allowed Amount | 14507.3 |
| Total Medicare Payment Amount | 9851.56 |
| Total Medicare Standardized Payment Amount | 12283.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 19 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 344 |
| Total Drug Medicare AllowedAmount | 259.34 |
| Total Drug Medicare PaymentAmount | 248.68 |
| Total Drug Medicare Standardized Payment Amount | 248.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 313 |
| Number Of Medicare Beneficiaries With Medical Services | 81 |
| Total Medical Submitted Charge Amount | 36413 |
| Total Medical Medicare Allowed Amount | 14247.96 |
| Total Medical Medicare Payment Amount | 9602.88 |
| Total Medical Medicare Standardized Payment Amount | 12035.04 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 43 |
| Number Of Beneficiaries Age 75 to 84 | 12 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 53 |
| Number Of Male Beneficiaries | 28 |
| 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 | 69 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8709 |