| National Provider Identifier [NPI]: | 1659373587 |
| Last Name Of The Provider | KELLETT |
| First Name Of The Provider | HELEN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | PROVENA MERCY MEDICAL CENTER / PATHOLOGY DEPARTMENT |
| Street Address 2 Of The Provider | 1325 NORTH HIGHLAND AVENUE |
| City Of The Provider | AURORA |
| Zip Code Of The Provider | 60506 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 4136 |
| Number Of Medicare Beneficiaries | 1589 |
| Total Submitted Charge Amount | 430935 |
| Total Medicare Allowed Amount | 112378.01 |
| Total Medicare Payment Amount | 86146.02 |
| Total Medicare Standardized Payment Amount | 82534.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1871 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1871 |
| Total Drug Medicare AllowedAmount | 327.1 |
| Total Drug Medicare PaymentAmount | 204.91 |
| Total Drug Medicare Standardized Payment Amount | 204.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 102 |
| Number Of Medical Services | 2265 |
| Number Of Medicare Beneficiaries With Medical Services | 1589 |
| Total Medical Submitted Charge Amount | 429064 |
| Total Medical Medicare Allowed Amount | 112050.91 |
| Total Medical Medicare Payment Amount | 85941.11 |
| Total Medical Medicare Standardized Payment Amount | 82329.66 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 252 |
| Number Of Beneficiaries Age 65 to 74 | 681 |
| Number Of Beneficiaries Age 75 to 84 | 454 |
| Number Of Beneficiaries Age Greater 84 | 202 |
| Number Of Female Beneficiaries | 997 |
| Number Of Male Beneficiaries | 592 |
| Number Of Non Hispanic White Beneficiaries | 1289 |
| Number Of Black or African American Beneficiaries | 119 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 150 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1202 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 387 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.534 |