| National Provider Identifier [NPI]: | 1487629291 |
| Last Name Of The Provider | MCCALLA |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 455 N SIOUX POINT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAKOTA DUNES |
| Zip Code Of The Provider | 570495327 |
| State Code Of The Provider | SD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 12901 |
| Number Of Medicare Beneficiaries | 1120 |
| Total Submitted Charge Amount | 1214291.25 |
| Total Medicare Allowed Amount | 414551.32 |
| Total Medicare Payment Amount | 314307.17 |
| Total Medicare Standardized Payment Amount | 321674.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 7980 |
| Number Of Medicare Beneficiaries With Drug Services | 112 |
| Total Drug Submitted ChargeAmount | 189966.5 |
| Total Drug Medicare AllowedAmount | 108040.78 |
| Total Drug Medicare PaymentAmount | 83414.18 |
| Total Drug Medicare Standardized Payment Amount | 83414.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 115 |
| Number Of Medical Services | 4921 |
| Number Of Medicare Beneficiaries With Medical Services | 1120 |
| Total Medical Submitted Charge Amount | 1024324.75 |
| Total Medical Medicare Allowed Amount | 306510.54 |
| Total Medical Medicare Payment Amount | 230892.99 |
| Total Medical Medicare Standardized Payment Amount | 238259.89 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 84 |
| Number Of Beneficiaries Age 65 to 74 | 402 |
| Number Of Beneficiaries Age 75 to 84 | 411 |
| Number Of Beneficiaries Age Greater 84 | 223 |
| Number Of Female Beneficiaries | 266 |
| Number Of Male Beneficiaries | 854 |
| Number Of Non Hispanic White Beneficiaries | 1068 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 15 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 970 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 150 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 27 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2069 |