| National Provider Identifier [NPI]: | 1366552762 |
| Last Name Of The Provider | FREDERICK |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 W 10TH ST |
| Street Address 2 Of The Provider | STE A |
| City Of The Provider | ROLLA |
| Zip Code Of The Provider | 65401 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 1134 |
| Number Of Medicare Beneficiaries | 238 |
| Total Submitted Charge Amount | 294708.96 |
| Total Medicare Allowed Amount | 93082.64 |
| Total Medicare Payment Amount | 70934.92 |
| Total Medicare Standardized Payment Amount | 75899.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 483 |
| Number Of Medicare Beneficiaries With Drug Services | 67 |
| Total Drug Submitted ChargeAmount | 33000.96 |
| Total Drug Medicare AllowedAmount | 13389.62 |
| Total Drug Medicare PaymentAmount | 10355.11 |
| Total Drug Medicare Standardized Payment Amount | 10355.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 651 |
| Number Of Medicare Beneficiaries With Medical Services | 238 |
| Total Medical Submitted Charge Amount | 261708 |
| Total Medical Medicare Allowed Amount | 79693.02 |
| Total Medical Medicare Payment Amount | 60579.81 |
| Total Medical Medicare Standardized Payment Amount | 65543.9 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 90 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 143 |
| Number Of Male Beneficiaries | 95 |
| 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 | 188 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2866 |