| National Provider Identifier [NPI]: | 1992824007 |
| Last Name Of The Provider | POWELL |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 421 KINGSLEY AVE |
| Street Address 2 Of The Provider | SUITE 402 |
| City Of The Provider | ORANGE PARK |
| Zip Code Of The Provider | 320734897 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 113795 |
| Number Of Medicare Beneficiaries | 1826 |
| Total Submitted Charge Amount | 6437467.83 |
| Total Medicare Allowed Amount | 3272357.45 |
| Total Medicare Payment Amount | 2943277.69 |
| Total Medicare Standardized Payment Amount | 2441631.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 21 |
| Number Of Drug Services | 16138 |
| Number Of Medicare Beneficiaries With Drug Services | 411 |
| Total Drug Submitted ChargeAmount | 274066 |
| Total Drug Medicare AllowedAmount | 69913.41 |
| Total Drug Medicare PaymentAmount | 54161.21 |
| Total Drug Medicare Standardized Payment Amount | 54161.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 97657 |
| Number Of Medicare Beneficiaries With Medical Services | 1826 |
| Total Medical Submitted Charge Amount | 6163401.83 |
| Total Medical Medicare Allowed Amount | 3202444.04 |
| Total Medical Medicare Payment Amount | 2889116.48 |
| Total Medical Medicare Standardized Payment Amount | 2387470.11 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 883 |
| Number Of Beneficiaries Age 65 to 74 | 633 |
| Number Of Beneficiaries Age 75 to 84 | 255 |
| Number Of Beneficiaries Age Greater 84 | 55 |
| Number Of Female Beneficiaries | 1122 |
| Number Of Male Beneficiaries | 704 |
| Number Of Non Hispanic White Beneficiaries | 1434 |
| Number Of Black or African American Beneficiaries | 298 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 55 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1085 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 741 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 72 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3959 |