| National Provider Identifier [NPI]: | 1013072453 |
| Last Name Of The Provider | HENNESSY |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 90 MORGAN ST |
| Street Address 2 Of The Provider | STE 202 |
| City Of The Provider | STAMFORD |
| Zip Code Of The Provider | 069055466 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 1500 |
| Number Of Medicare Beneficiaries | 242 |
| Total Submitted Charge Amount | 153630.88 |
| Total Medicare Allowed Amount | 112600.82 |
| Total Medicare Payment Amount | 79953.09 |
| Total Medicare Standardized Payment Amount | 76627.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 115 |
| Number Of Medicare Beneficiaries With Drug Services | 105 |
| Total Drug Submitted ChargeAmount | 5325 |
| Total Drug Medicare AllowedAmount | 4042.11 |
| Total Drug Medicare PaymentAmount | 3959.5 |
| Total Drug Medicare Standardized Payment Amount | 3959.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1385 |
| Number Of Medicare Beneficiaries With Medical Services | 242 |
| Total Medical Submitted Charge Amount | 148305.88 |
| Total Medical Medicare Allowed Amount | 108558.71 |
| Total Medical Medicare Payment Amount | 75993.59 |
| Total Medical Medicare Standardized Payment Amount | 72668 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 85 |
| Number Of Beneficiaries Age 75 to 84 | 82 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 92 |
| Number Of Non Hispanic White Beneficiaries | 191 |
| Number Of Black or African American Beneficiaries | 39 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 196 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0042 |