| National Provider Identifier [NPI]: | 1114952165 |
| Last Name Of The Provider | KELLY |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 72980 FRED WARING DR. |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | PALM DESERT |
| Zip Code Of The Provider | 922609339 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 216 |
| Number Of Services | 17968 |
| Number Of Medicare Beneficiaries | 8000 |
| Total Submitted Charge Amount | 4804203.01 |
| Total Medicare Allowed Amount | 2780828.38 |
| Total Medicare Payment Amount | 2121811.72 |
| Total Medicare Standardized Payment Amount | 2045985.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1925 |
| Number Of Medicare Beneficiaries With Drug Services | 1589 |
| Total Drug Submitted ChargeAmount | 9683 |
| Total Drug Medicare AllowedAmount | 3026.01 |
| Total Drug Medicare PaymentAmount | 2366.21 |
| Total Drug Medicare Standardized Payment Amount | 2366.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 211 |
| Number Of Medical Services | 16043 |
| Number Of Medicare Beneficiaries With Medical Services | 7997 |
| Total Medical Submitted Charge Amount | 4794520.01 |
| Total Medical Medicare Allowed Amount | 2777802.37 |
| Total Medical Medicare Payment Amount | 2119445.51 |
| Total Medical Medicare Standardized Payment Amount | 2043619.13 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 998 |
| Number Of Beneficiaries Age 65 to 74 | 3495 |
| Number Of Beneficiaries Age 75 to 84 | 2604 |
| Number Of Beneficiaries Age Greater 84 | 903 |
| Number Of Female Beneficiaries | 4703 |
| Number Of Male Beneficiaries | 3297 |
| Number Of Non Hispanic White Beneficiaries | 6354 |
| Number Of Black or African American Beneficiaries | 280 |
| Number Of AsianPacific Islander Beneficiaries | 229 |
| Number Of Hispanic Beneficiaries | 961 |
| Number Of American Indian Alaska Native Beneficiaries | 42 |
| Number Of Beneficiaries With Race Not Else where Classified | 134 |
| Number Of Beneficiaries With Medicare Only Entitlement | 6639 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1361 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1604 |