| National Provider Identifier [NPI]: | 1043270176 |
| Last Name Of The Provider | AMMONS |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1690 UNIVERSITY AVE W |
| Street Address 2 Of The Provider | SUITE 570 |
| City Of The Provider | SAINT PAUL |
| Zip Code Of The Provider | 551043723 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 857 |
| Number Of Medicare Beneficiaries | 408 |
| Total Submitted Charge Amount | 160444 |
| Total Medicare Allowed Amount | 64008.13 |
| Total Medicare Payment Amount | 45684.87 |
| Total Medicare Standardized Payment Amount | 46962.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 152 |
| Total Drug Medicare AllowedAmount | 10.23 |
| Total Drug Medicare PaymentAmount | 7.99 |
| Total Drug Medicare Standardized Payment Amount | 7.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 781 |
| Number Of Medicare Beneficiaries With Medical Services | 408 |
| Total Medical Submitted Charge Amount | 160292 |
| Total Medical Medicare Allowed Amount | 63997.9 |
| Total Medical Medicare Payment Amount | 45676.88 |
| Total Medical Medicare Standardized Payment Amount | 46954.48 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 135 |
| Number Of Beneficiaries Age 65 to 74 | 96 |
| Number Of Beneficiaries Age 75 to 84 | 96 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 237 |
| Number Of Male Beneficiaries | 171 |
| Number Of Non Hispanic White Beneficiaries | 313 |
| Number Of Black or African American Beneficiaries | 66 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 268 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 140 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3793 |