| National Provider Identifier [NPI]: | 1184606311 |
| Last Name Of The Provider | LEAVELL |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 6TH AVE N |
| Street Address 2 Of The Provider | CENTRACARE CLINIC |
| City Of The Provider | SAINT CLOUD |
| Zip Code Of The Provider | 563032735 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 1053 |
| Number Of Medicare Beneficiaries | 409 |
| Total Submitted Charge Amount | 263138.75 |
| Total Medicare Allowed Amount | 88302.57 |
| Total Medicare Payment Amount | 66540.92 |
| Total Medicare Standardized Payment Amount | 68922.32 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 144 |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 123 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 193 |
| Number Of Male Beneficiaries | 216 |
| Number Of Non Hispanic White Beneficiaries | 393 |
| 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 | 271 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 138 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.8198 |