| National Provider Identifier [NPI]: | 1316933260 |
| Last Name Of The Provider | SHANNON |
| First Name Of The Provider | PATRICK |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 987 BOARDMAN CANFIELD RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOARDMAN |
| Zip Code Of The Provider | 445124222 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 89 |
| Number Of Services | 7561 |
| Number Of Medicare Beneficiaries | 1216 |
| Total Submitted Charge Amount | 1053077.2 |
| Total Medicare Allowed Amount | 637481.55 |
| Total Medicare Payment Amount | 470009.36 |
| Total Medicare Standardized Payment Amount | 472282.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 174 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 9606.26 |
| Total Drug Medicare AllowedAmount | 7115.44 |
| Total Drug Medicare PaymentAmount | 5121.44 |
| Total Drug Medicare Standardized Payment Amount | 5121.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 87 |
| Number Of Medical Services | 7387 |
| Number Of Medicare Beneficiaries With Medical Services | 1216 |
| Total Medical Submitted Charge Amount | 1043470.94 |
| Total Medical Medicare Allowed Amount | 630366.11 |
| Total Medical Medicare Payment Amount | 464887.92 |
| Total Medical Medicare Standardized Payment Amount | 467160.95 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 630 |
| Number Of Beneficiaries Age 75 to 84 | 349 |
| Number Of Beneficiaries Age Greater 84 | 162 |
| Number Of Female Beneficiaries | 590 |
| Number Of Male Beneficiaries | 626 |
| Number Of Non Hispanic White Beneficiaries | 1183 |
| Number Of Black or African American Beneficiaries | 15 |
| 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 | 1135 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 81 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.01 |