| National Provider Identifier [NPI]: | 1861493702 |
| Last Name Of The Provider | SHANNON |
| First Name Of The Provider | GEORGE |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 106 ENTERPRISE CT |
| Street Address 2 Of The Provider | SUITE C |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 319043089 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 126 |
| Number Of Services | 8591.5 |
| Number Of Medicare Beneficiaries | 585 |
| Total Submitted Charge Amount | 607916.46 |
| Total Medicare Allowed Amount | 417467.66 |
| Total Medicare Payment Amount | 299380.47 |
| Total Medicare Standardized Payment Amount | 322230.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 484.5 |
| Number Of Medicare Beneficiaries With Drug Services | 318 |
| Total Drug Submitted ChargeAmount | 26595.74 |
| Total Drug Medicare AllowedAmount | 17243.74 |
| Total Drug Medicare PaymentAmount | 16306.89 |
| Total Drug Medicare Standardized Payment Amount | 16306.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 113 |
| Number Of Medical Services | 8107 |
| Number Of Medicare Beneficiaries With Medical Services | 585 |
| Total Medical Submitted Charge Amount | 581320.72 |
| Total Medical Medicare Allowed Amount | 400223.92 |
| Total Medical Medicare Payment Amount | 283073.58 |
| Total Medical Medicare Standardized Payment Amount | 305923.9 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 239 |
| Number Of Beneficiaries Age 75 to 84 | 209 |
| Number Of Beneficiaries Age Greater 84 | 103 |
| Number Of Female Beneficiaries | 363 |
| Number Of Male Beneficiaries | 222 |
| Number Of Non Hispanic White Beneficiaries | 532 |
| 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 | 562 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0586 |