| National Provider Identifier [NPI]: | 1982648937 |
| Last Name Of The Provider | KELLAM |
| First Name Of The Provider | D |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 E 20TH ST |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | CHEYENNE |
| Zip Code Of The Provider | 820013859 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 236 |
| Number Of Services | 20815 |
| Number Of Medicare Beneficiaries | 3105 |
| Total Submitted Charge Amount | 573186.19 |
| Total Medicare Allowed Amount | 432057.06 |
| Total Medicare Payment Amount | 332371.46 |
| Total Medicare Standardized Payment Amount | 338217.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 15082 |
| Number Of Medicare Beneficiaries With Drug Services | 221 |
| Total Drug Submitted ChargeAmount | 4255.11 |
| Total Drug Medicare AllowedAmount | 3932.52 |
| Total Drug Medicare PaymentAmount | 3071.06 |
| Total Drug Medicare Standardized Payment Amount | 3071.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 232 |
| Number Of Medical Services | 5733 |
| Number Of Medicare Beneficiaries With Medical Services | 3105 |
| Total Medical Submitted Charge Amount | 568931.08 |
| Total Medical Medicare Allowed Amount | 428124.54 |
| Total Medical Medicare Payment Amount | 329300.4 |
| Total Medical Medicare Standardized Payment Amount | 335146.17 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 468 |
| Number Of Beneficiaries Age 65 to 74 | 1209 |
| Number Of Beneficiaries Age 75 to 84 | 969 |
| Number Of Beneficiaries Age Greater 84 | 459 |
| Number Of Female Beneficiaries | 1992 |
| Number Of Male Beneficiaries | 1113 |
| Number Of Non Hispanic White Beneficiaries | 2753 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 254 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2489 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 616 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2495 |