| National Provider Identifier [NPI]: | 1245524214 |
| Last Name Of The Provider | CONNOLLY |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 HOSPITAL DR |
| Street Address 2 Of The Provider | EMERGENCY DEPARTMENT |
| City Of The Provider | LEWISBURG |
| Zip Code Of The Provider | 178379350 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 302 |
| Number Of Medicare Beneficiaries | 269 |
| Total Submitted Charge Amount | 358032 |
| Total Medicare Allowed Amount | 45532.95 |
| Total Medicare Payment Amount | 35491.9 |
| Total Medicare Standardized Payment Amount | 35855.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 302 |
| Number Of Medicare Beneficiaries With Medical Services | 269 |
| Total Medical Submitted Charge Amount | 358032 |
| Total Medical Medicare Allowed Amount | 45532.95 |
| Total Medical Medicare Payment Amount | 35491.9 |
| Total Medical Medicare Standardized Payment Amount | 35855.67 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 83 |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 64 |
| Number Of Beneficiaries Age Greater 84 | 62 |
| Number Of Female Beneficiaries | 149 |
| Number Of Male Beneficiaries | 120 |
| Number Of Non Hispanic White Beneficiaries | 251 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 169 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 100 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.8359 |