| National Provider Identifier [NPI]: | 1770565384 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3643 W FRONT ST |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | TRAVERSE CITY |
| Zip Code Of The Provider | 496847759 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 3786 |
| Number Of Medicare Beneficiaries | 965 |
| Total Submitted Charge Amount | 330632 |
| Total Medicare Allowed Amount | 224460.82 |
| Total Medicare Payment Amount | 162088.62 |
| Total Medicare Standardized Payment Amount | 167872.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 4087 |
| Total Drug Medicare AllowedAmount | 3526.07 |
| Total Drug Medicare PaymentAmount | 2741.91 |
| Total Drug Medicare Standardized Payment Amount | 2741.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 3752 |
| Number Of Medicare Beneficiaries With Medical Services | 965 |
| Total Medical Submitted Charge Amount | 326545 |
| Total Medical Medicare Allowed Amount | 220934.75 |
| Total Medical Medicare Payment Amount | 159346.71 |
| Total Medical Medicare Standardized Payment Amount | 165130.61 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 85 |
| Number Of Beneficiaries Age 65 to 74 | 456 |
| Number Of Beneficiaries Age 75 to 84 | 291 |
| Number Of Beneficiaries Age Greater 84 | 133 |
| Number Of Female Beneficiaries | 486 |
| Number Of Male Beneficiaries | 479 |
| Number Of Non Hispanic White Beneficiaries | 949 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 862 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 103 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0034 |