| National Provider Identifier [NPI]: | 1679543102 |
| Last Name Of The Provider | KELLUM |
| First Name Of The Provider | RONALD |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4433 LEISURE TIME |
| Street Address 2 Of The Provider | |
| City Of The Provider | DIAMONDHEAD |
| Zip Code Of The Provider | 395253259 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 1686 |
| Number Of Medicare Beneficiaries | 381 |
| Total Submitted Charge Amount | 308154 |
| Total Medicare Allowed Amount | 153976.75 |
| Total Medicare Payment Amount | 110029.12 |
| Total Medicare Standardized Payment Amount | 123634.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 105 |
| Number Of Medicare Beneficiaries With Drug Services | 78 |
| Total Drug Submitted ChargeAmount | 4058 |
| Total Drug Medicare AllowedAmount | 657.24 |
| Total Drug Medicare PaymentAmount | 605.68 |
| Total Drug Medicare Standardized Payment Amount | 605.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 1581 |
| Number Of Medicare Beneficiaries With Medical Services | 381 |
| Total Medical Submitted Charge Amount | 304096 |
| Total Medical Medicare Allowed Amount | 153319.51 |
| Total Medical Medicare Payment Amount | 109423.44 |
| Total Medical Medicare Standardized Payment Amount | 123029.3 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 146 |
| Number Of Beneficiaries Age 75 to 84 | 111 |
| Number Of Beneficiaries Age Greater 84 | 62 |
| Number Of Female Beneficiaries | 217 |
| Number Of Male Beneficiaries | 164 |
| Number Of Non Hispanic White Beneficiaries | 351 |
| Number Of Black or African American Beneficiaries | 18 |
| 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 | 287 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 94 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 6 |
| 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 | 21 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1346 |