| National Provider Identifier [NPI]: | 1861498768 |
| Last Name Of The Provider | CHAMBELLAN |
| First Name Of The Provider | KEN |
| Middle Initial Of The Provider | Y |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3515 RICHMOND RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TEXARKANA |
| Zip Code Of The Provider | 755030711 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 100 |
| Number Of Services | 3728 |
| Number Of Medicare Beneficiaries | 497 |
| Total Submitted Charge Amount | 268394 |
| Total Medicare Allowed Amount | 83845.28 |
| Total Medicare Payment Amount | 60474.28 |
| Total Medicare Standardized Payment Amount | 76141.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 21 |
| Number Of Drug Services | 1681 |
| Number Of Medicare Beneficiaries With Drug Services | 189 |
| Total Drug Submitted ChargeAmount | 32889 |
| Total Drug Medicare AllowedAmount | 1232.35 |
| Total Drug Medicare PaymentAmount | 868.31 |
| Total Drug Medicare Standardized Payment Amount | 868.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 2047 |
| Number Of Medicare Beneficiaries With Medical Services | 497 |
| Total Medical Submitted Charge Amount | 235505 |
| Total Medical Medicare Allowed Amount | 82612.93 |
| Total Medical Medicare Payment Amount | 59605.97 |
| Total Medical Medicare Standardized Payment Amount | 75272.86 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 198 |
| Number Of Beneficiaries Age 65 to 74 | 190 |
| Number Of Beneficiaries Age 75 to 84 | 89 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 289 |
| Number Of Male Beneficiaries | 208 |
| Number Of Non Hispanic White Beneficiaries | 397 |
| Number Of Black or African American Beneficiaries | 88 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 340 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 157 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0531 |