| National Provider Identifier [NPI]: | 1528060654 |
| Last Name Of The Provider | GANNON |
| First Name Of The Provider | MICHAEL |
| 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 | 11452 SPACE CENTER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 77059 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 376 |
| Number Of Medicare Beneficiaries | 150 |
| Total Submitted Charge Amount | 48169 |
| Total Medicare Allowed Amount | 23700.59 |
| Total Medicare Payment Amount | 16703.64 |
| Total Medicare Standardized Payment Amount | 16736.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 58 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 1904 |
| Total Drug Medicare AllowedAmount | 659.6 |
| Total Drug Medicare PaymentAmount | 626.52 |
| Total Drug Medicare Standardized Payment Amount | 626.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 318 |
| Number Of Medicare Beneficiaries With Medical Services | 150 |
| Total Medical Submitted Charge Amount | 46265 |
| Total Medical Medicare Allowed Amount | 23040.99 |
| Total Medical Medicare Payment Amount | 16077.12 |
| Total Medical Medicare Standardized Payment Amount | 16110.46 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 110 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 74 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | 134 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7533 |