| National Provider Identifier [NPI]: | 1033111331 |
| Last Name Of The Provider | HOLMES |
| First Name Of The Provider | JED |
| 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 | 7111 E 21ST STREET N |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | WICHITA |
| Zip Code Of The Provider | 67206 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 121 |
| Number Of Services | 5386 |
| Number Of Medicare Beneficiaries | 517 |
| Total Submitted Charge Amount | 307933.25 |
| Total Medicare Allowed Amount | 153626.22 |
| Total Medicare Payment Amount | 114953.82 |
| Total Medicare Standardized Payment Amount | 125281.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 18 |
| Number Of Drug Services | 1728 |
| Number Of Medicare Beneficiaries With Drug Services | 233 |
| Total Drug Submitted ChargeAmount | 17102.25 |
| Total Drug Medicare AllowedAmount | 7594.14 |
| Total Drug Medicare PaymentAmount | 6150.36 |
| Total Drug Medicare Standardized Payment Amount | 6150.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 103 |
| Number Of Medical Services | 3658 |
| Number Of Medicare Beneficiaries With Medical Services | 517 |
| Total Medical Submitted Charge Amount | 290831 |
| Total Medical Medicare Allowed Amount | 146032.08 |
| Total Medical Medicare Payment Amount | 108803.46 |
| Total Medical Medicare Standardized Payment Amount | 119131.61 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 238 |
| Number Of Beneficiaries Age 75 to 84 | 160 |
| Number Of Beneficiaries Age Greater 84 | 69 |
| Number Of Female Beneficiaries | 283 |
| Number Of Male Beneficiaries | 234 |
| Number Of Non Hispanic White Beneficiaries | 488 |
| Number Of Black or African American Beneficiaries | 14 |
| 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 | 478 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 38 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 21 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9377 |