| National Provider Identifier [NPI]: | 1417943713 |
| Last Name Of The Provider | CONNELLY |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6100 HARRIS PKWY |
| Street Address 2 Of The Provider | SUITE 285 |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761324127 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 3694 |
| Number Of Medicare Beneficiaries | 873 |
| Total Submitted Charge Amount | 792302 |
| Total Medicare Allowed Amount | 307812.35 |
| Total Medicare Payment Amount | 234179.94 |
| Total Medicare Standardized Payment Amount | 239883.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 2165 |
| Total Drug Medicare AllowedAmount | 1431.7 |
| Total Drug Medicare PaymentAmount | 1403.1 |
| Total Drug Medicare Standardized Payment Amount | 1403.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 3662 |
| Number Of Medicare Beneficiaries With Medical Services | 873 |
| Total Medical Submitted Charge Amount | 790137 |
| Total Medical Medicare Allowed Amount | 306380.65 |
| Total Medical Medicare Payment Amount | 232776.84 |
| Total Medical Medicare Standardized Payment Amount | 238480.11 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 102 |
| Number Of Beneficiaries Age 65 to 74 | 299 |
| Number Of Beneficiaries Age 75 to 84 | 326 |
| Number Of Beneficiaries Age Greater 84 | 146 |
| Number Of Female Beneficiaries | 482 |
| Number Of Male Beneficiaries | 391 |
| Number Of Non Hispanic White Beneficiaries | 747 |
| Number Of Black or African American Beneficiaries | 86 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 736 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 137 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 23 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 52 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 59 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.5748 |