| National Provider Identifier [NPI]: | 1093976540 |
| Last Name Of The Provider | HENNINGSON-KAYE |
| First Name Of The Provider | KELSEY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 450 EASTVOLD AVE |
| Street Address 2 Of The Provider | ORTONVILLE AREA HEALTH SERVICES/NORTHSIDE MEDICAL CLINI |
| City Of The Provider | ORTONVILLE |
| Zip Code Of The Provider | 562781252 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 184 |
| Number Of Medicare Beneficiaries | 66 |
| Total Submitted Charge Amount | 14137 |
| Total Medicare Allowed Amount | 6926.28 |
| Total Medicare Payment Amount | 5500.73 |
| Total Medicare Standardized Payment Amount | 6311.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 1606 |
| Total Drug Medicare AllowedAmount | 912.36 |
| Total Drug Medicare PaymentAmount | 884.28 |
| Total Drug Medicare Standardized Payment Amount | 884.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 148 |
| Number Of Medicare Beneficiaries With Medical Services | 66 |
| Total Medical Submitted Charge Amount | 12531 |
| Total Medical Medicare Allowed Amount | 6013.92 |
| Total Medical Medicare Payment Amount | 4616.45 |
| Total Medical Medicare Standardized Payment Amount | 5427.3 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 20 |
| Number Of Beneficiaries Age 75 to 84 | 23 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 37 |
| Number Of Male Beneficiaries | 29 |
| Number Of Non Hispanic White Beneficiaries | 66 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.123 |