| National Provider Identifier [NPI]: | 1215924253 |
| Last Name Of The Provider | KELLEY |
| First Name Of The Provider | MARTY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2916 HAMILTON BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SIOUX CITY |
| Zip Code Of The Provider | 511042429 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 6281 |
| Number Of Medicare Beneficiaries | 1753 |
| Total Submitted Charge Amount | 623186 |
| Total Medicare Allowed Amount | 354098.88 |
| Total Medicare Payment Amount | 244908.53 |
| Total Medicare Standardized Payment Amount | 263617.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 338 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 19004 |
| Total Drug Medicare AllowedAmount | 14559.9 |
| Total Drug Medicare PaymentAmount | 11404.2 |
| Total Drug Medicare Standardized Payment Amount | 11404.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 5943 |
| Number Of Medicare Beneficiaries With Medical Services | 1753 |
| Total Medical Submitted Charge Amount | 604182 |
| Total Medical Medicare Allowed Amount | 339538.98 |
| Total Medical Medicare Payment Amount | 233504.33 |
| Total Medical Medicare Standardized Payment Amount | 252213.62 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 201 |
| Number Of Beneficiaries Age 65 to 74 | 399 |
| Number Of Beneficiaries Age 75 to 84 | 495 |
| Number Of Beneficiaries Age Greater 84 | 658 |
| Number Of Female Beneficiaries | 1119 |
| Number Of Male Beneficiaries | 634 |
| Number Of Non Hispanic White Beneficiaries | 1708 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1168 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 585 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4908 |