| National Provider Identifier [NPI]: | 1528164787 |
| Last Name Of The Provider | KELLER |
| First Name Of The Provider | STEPHANIE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 550 E TIMBER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | RHINELANDER |
| Zip Code Of The Provider | 545012894 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 1020 |
| Number Of Medicare Beneficiaries | 258 |
| Total Submitted Charge Amount | 39814.95 |
| Total Medicare Allowed Amount | 32505.79 |
| Total Medicare Payment Amount | 18235.82 |
| Total Medicare Standardized Payment Amount | 23112.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 53 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 342.7 |
| Total Drug Medicare AllowedAmount | 341.68 |
| Total Drug Medicare PaymentAmount | 235.68 |
| Total Drug Medicare Standardized Payment Amount | 235.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 967 |
| Number Of Medicare Beneficiaries With Medical Services | 258 |
| Total Medical Submitted Charge Amount | 39472.25 |
| Total Medical Medicare Allowed Amount | 32164.11 |
| Total Medical Medicare Payment Amount | 18000.14 |
| Total Medical Medicare Standardized Payment Amount | 22876.43 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 132 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 108 |
| Number Of Non Hispanic White Beneficiaries | 244 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 241 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7967 |