| National Provider Identifier [NPI]: | 1659394005 |
| Last Name Of The Provider | KENNELL |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10850 E TRAVERSE HWY |
| Street Address 2 Of The Provider | SUITE 60 |
| City Of The Provider | TRAVERSE CITY |
| Zip Code Of The Provider | 496841364 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 179 |
| Number Of Services | 5560 |
| Number Of Medicare Beneficiaries | 3976 |
| Total Submitted Charge Amount | 456156 |
| Total Medicare Allowed Amount | 159562 |
| Total Medicare Payment Amount | 118427.76 |
| Total Medicare Standardized Payment Amount | 122120.49 |
| 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 | 179 |
| Number Of Medical Services | 5560 |
| Number Of Medicare Beneficiaries With Medical Services | 3976 |
| Total Medical Submitted Charge Amount | 456156 |
| Total Medical Medicare Allowed Amount | 159562 |
| Total Medical Medicare Payment Amount | 118427.76 |
| Total Medical Medicare Standardized Payment Amount | 122120.49 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 859 |
| Number Of Beneficiaries Age 65 to 74 | 1331 |
| Number Of Beneficiaries Age 75 to 84 | 1139 |
| Number Of Beneficiaries Age Greater 84 | 647 |
| Number Of Female Beneficiaries | 2187 |
| Number Of Male Beneficiaries | 1789 |
| Number Of Non Hispanic White Beneficiaries | 3851 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 54 |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2826 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1150 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5204 |