| National Provider Identifier [NPI]: | 1023092533 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | MARILYN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 202 N 1ST ST |
| Street Address 2 Of The Provider | STE A |
| City Of The Provider | BOONEVILLE |
| Zip Code Of The Provider | 388292718 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 209 |
| Number Of Medicare Beneficiaries | 86 |
| Total Submitted Charge Amount | 14385 |
| Total Medicare Allowed Amount | 7359.07 |
| Total Medicare Payment Amount | 4753.8 |
| Total Medicare Standardized Payment Amount | 6160.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 74 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 1186 |
| Total Drug Medicare AllowedAmount | 278.59 |
| Total Drug Medicare PaymentAmount | 160.94 |
| Total Drug Medicare Standardized Payment Amount | 160.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 135 |
| Number Of Medicare Beneficiaries With Medical Services | 86 |
| Total Medical Submitted Charge Amount | 13199 |
| Total Medical Medicare Allowed Amount | 7080.48 |
| Total Medical Medicare Payment Amount | 4592.86 |
| Total Medical Medicare Standardized Payment Amount | 5999.75 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 31 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 56 |
| Number Of Male Beneficiaries | 30 |
| 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 | 57 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9216 |