| National Provider Identifier [NPI]: | 1962462937 |
| Last Name Of The Provider | KELLER |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 108 NORTH PARK DR. |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAYETTEVILLE |
| Zip Code Of The Provider | 30214 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 2287 |
| Number Of Medicare Beneficiaries | 482 |
| Total Submitted Charge Amount | 281166 |
| Total Medicare Allowed Amount | 150339.32 |
| Total Medicare Payment Amount | 103734.2 |
| Total Medicare Standardized Payment Amount | 104538.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 93 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 1864 |
| Total Drug Medicare AllowedAmount | 940.36 |
| Total Drug Medicare PaymentAmount | 857.74 |
| Total Drug Medicare Standardized Payment Amount | 857.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 2194 |
| Number Of Medicare Beneficiaries With Medical Services | 482 |
| Total Medical Submitted Charge Amount | 279302 |
| Total Medical Medicare Allowed Amount | 149398.96 |
| Total Medical Medicare Payment Amount | 102876.46 |
| Total Medical Medicare Standardized Payment Amount | 103681.02 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 209 |
| Number Of Beneficiaries Age 75 to 84 | 179 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 261 |
| Number Of Male Beneficiaries | 221 |
| Number Of Non Hispanic White Beneficiaries | 449 |
| Number Of Black or African American Beneficiaries | 18 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 2 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 8 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.916 |