| National Provider Identifier [NPI]: | 1306801071 |
| Last Name Of The Provider | WARREN |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 763 E US HIGHWAY 80 STE 200 |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORNEY |
| Zip Code Of The Provider | 751268680 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 88 |
| Number Of Services | 16403 |
| Number Of Medicare Beneficiaries | 2626 |
| Total Submitted Charge Amount | 2111341.47 |
| Total Medicare Allowed Amount | 882661.61 |
| Total Medicare Payment Amount | 635732.8 |
| Total Medicare Standardized Payment Amount | 671561.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 187 |
| Number Of Medicare Beneficiaries With Drug Services | 70 |
| Total Drug Submitted ChargeAmount | 7340.97 |
| Total Drug Medicare AllowedAmount | 6148.63 |
| Total Drug Medicare PaymentAmount | 4786.7 |
| Total Drug Medicare Standardized Payment Amount | 4786.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 86 |
| Number Of Medical Services | 16216 |
| Number Of Medicare Beneficiaries With Medical Services | 2626 |
| Total Medical Submitted Charge Amount | 2104000.5 |
| Total Medical Medicare Allowed Amount | 876512.98 |
| Total Medical Medicare Payment Amount | 630946.1 |
| Total Medical Medicare Standardized Payment Amount | 666775.28 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 136 |
| Number Of Beneficiaries Age 65 to 74 | 1315 |
| Number Of Beneficiaries Age 75 to 84 | 873 |
| Number Of Beneficiaries Age Greater 84 | 302 |
| Number Of Female Beneficiaries | 1346 |
| Number Of Male Beneficiaries | 1280 |
| Number Of Non Hispanic White Beneficiaries | 2505 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2459 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 167 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0202 |