| National Provider Identifier [NPI]: | 1518943554 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | MAUREEN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4491 BENT BROTHERS BLVD. |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLORADO CITY |
| Zip Code Of The Provider | 81019 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 1578 |
| Number Of Medicare Beneficiaries | 323 |
| Total Submitted Charge Amount | 212214.56 |
| Total Medicare Allowed Amount | 90122.99 |
| Total Medicare Payment Amount | 62388.26 |
| Total Medicare Standardized Payment Amount | 62556.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 155 |
| Number Of Medicare Beneficiaries With Drug Services | 116 |
| Total Drug Submitted ChargeAmount | 6603.96 |
| Total Drug Medicare AllowedAmount | 2533.25 |
| Total Drug Medicare PaymentAmount | 2460.04 |
| Total Drug Medicare Standardized Payment Amount | 2460.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 1423 |
| Number Of Medicare Beneficiaries With Medical Services | 323 |
| Total Medical Submitted Charge Amount | 205610.6 |
| Total Medical Medicare Allowed Amount | 87589.74 |
| Total Medical Medicare Payment Amount | 59928.22 |
| Total Medical Medicare Standardized Payment Amount | 60096.03 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 151 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 173 |
| Number Of Male Beneficiaries | 150 |
| Number Of Non Hispanic White Beneficiaries | 282 |
| 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 | 254 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1132 |