| National Provider Identifier [NPI]: | 1629158837 |
| Last Name Of The Provider | KELLER |
| First Name Of The Provider | MICHELE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 3RD CT SE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DEMOTTE |
| Zip Code Of The Provider | 463107400 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 1229 |
| Number Of Medicare Beneficiaries | 366 |
| Total Submitted Charge Amount | 92498 |
| Total Medicare Allowed Amount | 37871.6 |
| Total Medicare Payment Amount | 26401.97 |
| Total Medicare Standardized Payment Amount | 28421.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 125 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 3581 |
| Total Drug Medicare AllowedAmount | 1139.41 |
| Total Drug Medicare PaymentAmount | 1067.01 |
| Total Drug Medicare Standardized Payment Amount | 1067.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 1104 |
| Number Of Medicare Beneficiaries With Medical Services | 366 |
| Total Medical Submitted Charge Amount | 88917 |
| Total Medical Medicare Allowed Amount | 36732.19 |
| Total Medical Medicare Payment Amount | 25334.96 |
| Total Medical Medicare Standardized Payment Amount | 27354 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 172 |
| Number Of Beneficiaries Age 75 to 84 | 113 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 218 |
| Number Of Male Beneficiaries | 148 |
| 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 | 328 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0238 |