| National Provider Identifier [NPI]: | 1801835350 |
| Last Name Of The Provider | GREEN |
| First Name Of The Provider | KERRY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6112 E BROWN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 852054955 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 4341 |
| Number Of Medicare Beneficiaries | 916 |
| Total Submitted Charge Amount | 331014 |
| Total Medicare Allowed Amount | 229731.09 |
| Total Medicare Payment Amount | 170190.53 |
| Total Medicare Standardized Payment Amount | 172716.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 1007 |
| Number Of Medicare Beneficiaries With Drug Services | 363 |
| Total Drug Submitted ChargeAmount | 14818 |
| Total Drug Medicare AllowedAmount | 8242.85 |
| Total Drug Medicare PaymentAmount | 7387.24 |
| Total Drug Medicare Standardized Payment Amount | 7387.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 3334 |
| Number Of Medicare Beneficiaries With Medical Services | 916 |
| Total Medical Submitted Charge Amount | 316196 |
| Total Medical Medicare Allowed Amount | 221488.24 |
| Total Medical Medicare Payment Amount | 162803.29 |
| Total Medical Medicare Standardized Payment Amount | 165329.54 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 442 |
| Number Of Beneficiaries Age 75 to 84 | 319 |
| Number Of Beneficiaries Age Greater 84 | 122 |
| Number Of Female Beneficiaries | 512 |
| Number Of Male Beneficiaries | 404 |
| Number Of Non Hispanic White Beneficiaries | 871 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 903 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0273 |