| National Provider Identifier [NPI]: | 1770563710 |
| Last Name Of The Provider | KETTERLING |
| First Name Of The Provider | KEVAN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2525 KANEVILLE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | GENEVA |
| Zip Code Of The Provider | 601342578 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 1999 |
| Number Of Medicare Beneficiaries | 312 |
| Total Submitted Charge Amount | 672324.1 |
| Total Medicare Allowed Amount | 144004.8 |
| Total Medicare Payment Amount | 107936.44 |
| Total Medicare Standardized Payment Amount | 101189.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 795 |
| Number Of Medicare Beneficiaries With Drug Services | 130 |
| Total Drug Submitted ChargeAmount | 73991 |
| Total Drug Medicare AllowedAmount | 28079.52 |
| Total Drug Medicare PaymentAmount | 21972.85 |
| Total Drug Medicare Standardized Payment Amount | 21972.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 1204 |
| Number Of Medicare Beneficiaries With Medical Services | 312 |
| Total Medical Submitted Charge Amount | 598333.1 |
| Total Medical Medicare Allowed Amount | 115925.28 |
| Total Medical Medicare Payment Amount | 85963.59 |
| Total Medical Medicare Standardized Payment Amount | 79216.53 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 194 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 171 |
| Number Of Male Beneficiaries | 141 |
| Number Of Non Hispanic White Beneficiaries | 296 |
| 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 | 293 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 73 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.863 |