| National Provider Identifier [NPI]: | 1033178389 |
| Last Name Of The Provider | KEPHART |
| First Name Of The Provider | DALE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21 GEISINGER LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | LEWISTOWN |
| Zip Code Of The Provider | 170443400 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 3649 |
| Number Of Medicare Beneficiaries | 976 |
| Total Submitted Charge Amount | 468649 |
| Total Medicare Allowed Amount | 191338.34 |
| Total Medicare Payment Amount | 135066.2 |
| Total Medicare Standardized Payment Amount | 140210.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 537 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 5498 |
| Total Drug Medicare AllowedAmount | 954.36 |
| Total Drug Medicare PaymentAmount | 635.82 |
| Total Drug Medicare Standardized Payment Amount | 635.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 3112 |
| Number Of Medicare Beneficiaries With Medical Services | 976 |
| Total Medical Submitted Charge Amount | 463151 |
| Total Medical Medicare Allowed Amount | 190383.98 |
| Total Medical Medicare Payment Amount | 134430.38 |
| Total Medical Medicare Standardized Payment Amount | 139574.36 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 149 |
| Number Of Beneficiaries Age 65 to 74 | 387 |
| Number Of Beneficiaries Age 75 to 84 | 289 |
| Number Of Beneficiaries Age Greater 84 | 151 |
| Number Of Female Beneficiaries | 516 |
| Number Of Male Beneficiaries | 460 |
| Number Of Non Hispanic White Beneficiaries | 954 |
| 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 | 759 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 217 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.157 |