| National Provider Identifier [NPI]: | 1568478071 |
| Last Name Of The Provider | KENNEDY |
| First Name Of The Provider | GRACE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7307 S YALE AVE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741367049 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 2650 |
| Number Of Medicare Beneficiaries | 574 |
| Total Submitted Charge Amount | 505406.19 |
| Total Medicare Allowed Amount | 211852.73 |
| Total Medicare Payment Amount | 160034.63 |
| Total Medicare Standardized Payment Amount | 173330.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 59 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 742.62 |
| Total Drug Medicare AllowedAmount | 177.05 |
| Total Drug Medicare PaymentAmount | 172.43 |
| Total Drug Medicare Standardized Payment Amount | 172.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 2591 |
| Number Of Medicare Beneficiaries With Medical Services | 574 |
| Total Medical Submitted Charge Amount | 504663.57 |
| Total Medical Medicare Allowed Amount | 211675.68 |
| Total Medical Medicare Payment Amount | 159862.2 |
| Total Medical Medicare Standardized Payment Amount | 173158.36 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 107 |
| Number Of Beneficiaries Age 65 to 74 | 243 |
| Number Of Beneficiaries Age 75 to 84 | 174 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 328 |
| Number Of Male Beneficiaries | 246 |
| Number Of Non Hispanic White Beneficiaries | 479 |
| Number Of Black or African American Beneficiaries | 19 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 59 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 445 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 129 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 58 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.3008 |