| National Provider Identifier [NPI]: | 1285060947 |
| Last Name Of The Provider | DUNKIN |
| First Name Of The Provider | KELLIE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MSN NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 451 S PARK RIDGE RD |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | BLOOMINGTON |
| Zip Code Of The Provider | 474018589 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 263 |
| Number Of Medicare Beneficiaries | 88 |
| Total Submitted Charge Amount | 25954 |
| Total Medicare Allowed Amount | 16464.67 |
| Total Medicare Payment Amount | 12993.79 |
| Total Medicare Standardized Payment Amount | 15938.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 593 |
| Total Drug Medicare AllowedAmount | 191.47 |
| Total Drug Medicare PaymentAmount | 186.06 |
| Total Drug Medicare Standardized Payment Amount | 186.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 237 |
| Number Of Medicare Beneficiaries With Medical Services | 88 |
| Total Medical Submitted Charge Amount | 25361 |
| Total Medical Medicare Allowed Amount | 16273.2 |
| Total Medical Medicare Payment Amount | 12807.73 |
| Total Medical Medicare Standardized Payment Amount | 15752.78 |
| Average Age Of Beneficiaries | 49 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 53 |
| Number Of Male Beneficiaries | 35 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 67 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 64 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1486 |