| National Provider Identifier [NPI]: | 1528022779 |
| Last Name Of The Provider | KENNEDY |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14506 W GRANITE VALLEY DR |
| Street Address 2 Of The Provider | #124 |
| City Of The Provider | SUN CITY WEST |
| Zip Code Of The Provider | 853756010 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 12423 |
| Number Of Medicare Beneficiaries | 2008 |
| Total Submitted Charge Amount | 733693.17 |
| Total Medicare Allowed Amount | 668128.21 |
| Total Medicare Payment Amount | 482550.85 |
| Total Medicare Standardized Payment Amount | 480723.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 7955.82 |
| Total Drug Medicare AllowedAmount | 7927.88 |
| Total Drug Medicare PaymentAmount | 6187.01 |
| Total Drug Medicare Standardized Payment Amount | 6187.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 12352 |
| Number Of Medicare Beneficiaries With Medical Services | 2008 |
| Total Medical Submitted Charge Amount | 725737.35 |
| Total Medical Medicare Allowed Amount | 660200.33 |
| Total Medical Medicare Payment Amount | 476363.84 |
| Total Medical Medicare Standardized Payment Amount | 474536.4 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 986 |
| Number Of Beneficiaries Age 75 to 84 | 704 |
| Number Of Beneficiaries Age Greater 84 | 289 |
| Number Of Female Beneficiaries | 878 |
| Number Of Male Beneficiaries | 1130 |
| Number Of Non Hispanic White Beneficiaries | 1933 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1986 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9845 |