| National Provider Identifier [NPI]: | 1467636605 |
| Last Name Of The Provider | KELLER |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1008 W. CHERRY ST. |
| Street Address 2 Of The Provider | SUITE F |
| City Of The Provider | MARION |
| Zip Code Of The Provider | 62959 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 3694 |
| Number Of Medicare Beneficiaries | 630 |
| Total Submitted Charge Amount | 380905 |
| Total Medicare Allowed Amount | 246274.84 |
| Total Medicare Payment Amount | 167026.04 |
| Total Medicare Standardized Payment Amount | 174028.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 702 |
| Number Of Medicare Beneficiaries With Drug Services | 198 |
| Total Drug Submitted ChargeAmount | 6665 |
| Total Drug Medicare AllowedAmount | 3197.72 |
| Total Drug Medicare PaymentAmount | 2727.57 |
| Total Drug Medicare Standardized Payment Amount | 2727.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 2992 |
| Number Of Medicare Beneficiaries With Medical Services | 630 |
| Total Medical Submitted Charge Amount | 374240 |
| Total Medical Medicare Allowed Amount | 243077.12 |
| Total Medical Medicare Payment Amount | 164298.47 |
| Total Medical Medicare Standardized Payment Amount | 171301.16 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 278 |
| Number Of Beneficiaries Age 75 to 84 | 203 |
| Number Of Beneficiaries Age Greater 84 | 104 |
| Number Of Female Beneficiaries | 370 |
| Number Of Male Beneficiaries | 260 |
| 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 | 587 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1168 |