| National Provider Identifier [NPI]: | 1184606816 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1840 MEASE DR |
| Street Address 2 Of The Provider | SUITE 406 |
| City Of The Provider | SAFETY HARBOR |
| Zip Code Of The Provider | 346956602 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 12208 |
| Number Of Medicare Beneficiaries | 1626 |
| Total Submitted Charge Amount | 769652 |
| Total Medicare Allowed Amount | 581060.77 |
| Total Medicare Payment Amount | 423078.85 |
| Total Medicare Standardized Payment Amount | 419482.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 33 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 264 |
| Total Drug Medicare AllowedAmount | 58.83 |
| Total Drug Medicare PaymentAmount | 44.68 |
| Total Drug Medicare Standardized Payment Amount | 44.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 12175 |
| Number Of Medicare Beneficiaries With Medical Services | 1626 |
| Total Medical Submitted Charge Amount | 769388 |
| Total Medical Medicare Allowed Amount | 581001.94 |
| Total Medical Medicare Payment Amount | 423034.17 |
| Total Medical Medicare Standardized Payment Amount | 419437.66 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 501 |
| Number Of Beneficiaries Age 75 to 84 | 647 |
| Number Of Beneficiaries Age Greater 84 | 446 |
| Number Of Female Beneficiaries | 831 |
| Number Of Male Beneficiaries | 795 |
| Number Of Non Hispanic White Beneficiaries | 1587 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1596 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.19 |