| National Provider Identifier [NPI]: | 1285624692 |
| Last Name Of The Provider | KELLUM |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 770 PINE ST STE 290 |
| Street Address 2 Of The Provider | ATTN: RADIOLOGY DEPARTMENT |
| City Of The Provider | MACON |
| Zip Code Of The Provider | 312017516 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 236 |
| Number Of Services | 5862 |
| Number Of Medicare Beneficiaries | 2381 |
| Total Submitted Charge Amount | 587698.5 |
| Total Medicare Allowed Amount | 143570.54 |
| Total Medicare Payment Amount | 110801.5 |
| Total Medicare Standardized Payment Amount | 117246.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 2350 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 7050 |
| Total Drug Medicare AllowedAmount | 463.76 |
| Total Drug Medicare PaymentAmount | 363.5 |
| Total Drug Medicare Standardized Payment Amount | 363.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 235 |
| Number Of Medical Services | 3512 |
| Number Of Medicare Beneficiaries With Medical Services | 2381 |
| Total Medical Submitted Charge Amount | 580648.5 |
| Total Medical Medicare Allowed Amount | 143106.78 |
| Total Medical Medicare Payment Amount | 110438 |
| Total Medical Medicare Standardized Payment Amount | 116883.02 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 491 |
| Number Of Beneficiaries Age 65 to 74 | 880 |
| Number Of Beneficiaries Age 75 to 84 | 688 |
| Number Of Beneficiaries Age Greater 84 | 322 |
| Number Of Female Beneficiaries | 1396 |
| Number Of Male Beneficiaries | 985 |
| Number Of Non Hispanic White Beneficiaries | 1695 |
| Number Of Black or African American Beneficiaries | 646 |
| 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 | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1757 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 624 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.9094 |