| National Provider Identifier [NPI]: | 1225036023 |
| Last Name Of The Provider | KELLUM |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 446 CORPORATE DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HOUMA |
| Zip Code Of The Provider | 703603403 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 7315 |
| Number Of Medicare Beneficiaries | 1714 |
| Total Submitted Charge Amount | 2295255 |
| Total Medicare Allowed Amount | 940661.95 |
| Total Medicare Payment Amount | 686980.37 |
| Total Medicare Standardized Payment Amount | 733440.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 709 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 274460 |
| Total Drug Medicare AllowedAmount | 240413.96 |
| Total Drug Medicare PaymentAmount | 183485.06 |
| Total Drug Medicare Standardized Payment Amount | 183485.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 69 |
| Number Of Medical Services | 6606 |
| Number Of Medicare Beneficiaries With Medical Services | 1714 |
| Total Medical Submitted Charge Amount | 2020795 |
| Total Medical Medicare Allowed Amount | 700247.99 |
| Total Medical Medicare Payment Amount | 503495.31 |
| Total Medical Medicare Standardized Payment Amount | 549955.41 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 152 |
| Number Of Beneficiaries Age 65 to 74 | 738 |
| Number Of Beneficiaries Age 75 to 84 | 613 |
| Number Of Beneficiaries Age Greater 84 | 211 |
| Number Of Female Beneficiaries | 1051 |
| Number Of Male Beneficiaries | 663 |
| Number Of Non Hispanic White Beneficiaries | 1478 |
| Number Of Black or African American Beneficiaries | 179 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1471 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 243 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0406 |