| National Provider Identifier [NPI]: | 1942209366 |
| Last Name Of The Provider | KETCHUM |
| First Name Of The Provider | LYNN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11111 NALL AVE |
| Street Address 2 Of The Provider | SUITE 114 |
| City Of The Provider | LEAWOOD |
| Zip Code Of The Provider | 662111925 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Plastic and Reconstructive Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 1380 |
| Number Of Medicare Beneficiaries | 100 |
| Total Submitted Charge Amount | 48143.01 |
| Total Medicare Allowed Amount | 19785.79 |
| Total Medicare Payment Amount | 15200.05 |
| Total Medicare Standardized Payment Amount | 15756.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1026 |
| Number Of Medicare Beneficiaries With Drug Services | 88 |
| Total Drug Submitted ChargeAmount | 6396 |
| Total Drug Medicare AllowedAmount | 1829.43 |
| Total Drug Medicare PaymentAmount | 1423.15 |
| Total Drug Medicare Standardized Payment Amount | 1423.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 354 |
| Number Of Medicare Beneficiaries With Medical Services | 100 |
| Total Medical Submitted Charge Amount | 41747.01 |
| Total Medical Medicare Allowed Amount | 17956.36 |
| Total Medical Medicare Payment Amount | 13776.9 |
| Total Medical Medicare Standardized Payment Amount | 14333.04 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 54 |
| Number Of Male Beneficiaries | 46 |
| 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 | 100 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.862 |