| National Provider Identifier [NPI]: | 1780771261 |
| Last Name Of The Provider | KELLERMANN |
| First Name Of The Provider | KELSY |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1821 S WEBSTER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREEN BAY |
| Zip Code Of The Provider | 543012253 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 2202 |
| Number Of Medicare Beneficiaries | 443 |
| Total Submitted Charge Amount | 526569.25 |
| Total Medicare Allowed Amount | 96815.4 |
| Total Medicare Payment Amount | 74093.61 |
| Total Medicare Standardized Payment Amount | 83494.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 453 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 105904.25 |
| Total Drug Medicare AllowedAmount | 36587.04 |
| Total Drug Medicare PaymentAmount | 28400.88 |
| Total Drug Medicare Standardized Payment Amount | 28400.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 1749 |
| Number Of Medicare Beneficiaries With Medical Services | 443 |
| Total Medical Submitted Charge Amount | 420665 |
| Total Medical Medicare Allowed Amount | 60228.36 |
| Total Medical Medicare Payment Amount | 45692.73 |
| Total Medical Medicare Standardized Payment Amount | 55093.31 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 193 |
| Number Of Beneficiaries Age 75 to 84 | 135 |
| Number Of Beneficiaries Age Greater 84 | 64 |
| Number Of Female Beneficiaries | 126 |
| Number Of Male Beneficiaries | 317 |
| Number Of Non Hispanic White Beneficiaries | 428 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 374 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 29 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.2206 |