| National Provider Identifier [NPI]: | 1275794778 |
| Last Name Of The Provider | CHELMO |
| First Name Of The Provider | SAM |
| 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 | 3449 E REZANOF DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | KODIAK |
| Zip Code Of The Provider | 996156952 |
| State Code Of The Provider | AK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 630 |
| Number Of Medicare Beneficiaries | 133 |
| Total Submitted Charge Amount | 105979.5 |
| Total Medicare Allowed Amount | 38898.97 |
| Total Medicare Payment Amount | 27705.55 |
| Total Medicare Standardized Payment Amount | 22474.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 2362 |
| Total Drug Medicare AllowedAmount | 569.74 |
| Total Drug Medicare PaymentAmount | 558.38 |
| Total Drug Medicare Standardized Payment Amount | 558.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 599 |
| Number Of Medicare Beneficiaries With Medical Services | 133 |
| Total Medical Submitted Charge Amount | 103617.5 |
| Total Medical Medicare Allowed Amount | 38329.23 |
| Total Medical Medicare Payment Amount | 27147.17 |
| Total Medical Medicare Standardized Payment Amount | 21916.31 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | 44 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 66 |
| Number Of Male Beneficiaries | 67 |
| 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 | 83 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 22 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2149 |