| National Provider Identifier [NPI]: | 1902872831 |
| Last Name Of The Provider | KAULBACK |
| First Name Of The Provider | KYLE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 420 S JACKSON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | POTTSVILLE |
| Zip Code Of The Provider | 179013625 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 933 |
| Number Of Medicare Beneficiaries | 690 |
| Total Submitted Charge Amount | 599966 |
| Total Medicare Allowed Amount | 105759.69 |
| Total Medicare Payment Amount | 81776.82 |
| Total Medicare Standardized Payment Amount | 82615.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 933 |
| Number Of Medicare Beneficiaries With Medical Services | 690 |
| Total Medical Submitted Charge Amount | 599966 |
| Total Medical Medicare Allowed Amount | 105759.69 |
| Total Medical Medicare Payment Amount | 81776.82 |
| Total Medical Medicare Standardized Payment Amount | 82615.85 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 189 |
| Number Of Beneficiaries Age 65 to 74 | 140 |
| Number Of Beneficiaries Age 75 to 84 | 179 |
| Number Of Beneficiaries Age Greater 84 | 182 |
| Number Of Female Beneficiaries | 415 |
| Number Of Male Beneficiaries | 275 |
| Number Of Non Hispanic White Beneficiaries | 676 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 405 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 285 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6194 |