| National Provider Identifier [NPI]: | 1407886047 |
| Last Name Of The Provider | MCDONALD |
| First Name Of The Provider | KELLIE |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1701 N SENATE AVE |
| Street Address 2 Of The Provider | ROOM 1204A |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462021239 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 88 |
| Number Of Services | 3397 |
| Number Of Medicare Beneficiaries | 2370 |
| Total Submitted Charge Amount | 237745 |
| Total Medicare Allowed Amount | 80427.53 |
| Total Medicare Payment Amount | 59501.46 |
| Total Medicare Standardized Payment Amount | 62740.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 88 |
| Number Of Medical Services | 3397 |
| Number Of Medicare Beneficiaries With Medical Services | 2370 |
| Total Medical Submitted Charge Amount | 237745 |
| Total Medical Medicare Allowed Amount | 80427.53 |
| Total Medical Medicare Payment Amount | 59501.46 |
| Total Medical Medicare Standardized Payment Amount | 62740.87 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 836 |
| Number Of Beneficiaries Age 65 to 74 | 710 |
| Number Of Beneficiaries Age 75 to 84 | 517 |
| Number Of Beneficiaries Age Greater 84 | 307 |
| Number Of Female Beneficiaries | 1357 |
| Number Of Male Beneficiaries | 1013 |
| Number Of Non Hispanic White Beneficiaries | 1811 |
| Number Of Black or African American Beneficiaries | 502 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1287 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1083 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.5591 |