| National Provider Identifier [NPI]: | 1396713780 |
| Last Name Of The Provider | MCKENNA |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4909 N GLEN PARK PLACE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616144676 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 111 |
| Number Of Services | 19184 |
| Number Of Medicare Beneficiaries | 2614 |
| Total Submitted Charge Amount | 1761566.89 |
| Total Medicare Allowed Amount | 1319991.2 |
| Total Medicare Payment Amount | 986304.39 |
| Total Medicare Standardized Payment Amount | 989625.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 345 |
| Number Of Medicare Beneficiaries With Drug Services | 210 |
| Total Drug Submitted ChargeAmount | 7416.51 |
| Total Drug Medicare AllowedAmount | 615.58 |
| Total Drug Medicare PaymentAmount | 451.45 |
| Total Drug Medicare Standardized Payment Amount | 451.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 109 |
| Number Of Medical Services | 18839 |
| Number Of Medicare Beneficiaries With Medical Services | 2614 |
| Total Medical Submitted Charge Amount | 1754150.38 |
| Total Medical Medicare Allowed Amount | 1319375.62 |
| Total Medical Medicare Payment Amount | 985852.94 |
| Total Medical Medicare Standardized Payment Amount | 989174.23 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 207 |
| Number Of Beneficiaries Age 65 to 74 | 1135 |
| Number Of Beneficiaries Age 75 to 84 | 843 |
| Number Of Beneficiaries Age Greater 84 | 429 |
| Number Of Female Beneficiaries | 1261 |
| Number Of Male Beneficiaries | 1353 |
| Number Of Non Hispanic White Beneficiaries | 2508 |
| Number Of Black or African American Beneficiaries | 50 |
| 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 | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2357 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 257 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0564 |