| National Provider Identifier [NPI]: | 1285896852 |
| Last Name Of The Provider | SHANNON |
| First Name Of The Provider | CONNOR |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2160 S 1ST AVE |
| Street Address 2 Of The Provider | BUILDING 103, ROOM 3102 |
| City Of The Provider | MAYWOOD |
| Zip Code Of The Provider | 601533328 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 1036 |
| Number Of Medicare Beneficiaries | 526 |
| Total Submitted Charge Amount | 1015370 |
| Total Medicare Allowed Amount | 161311.02 |
| Total Medicare Payment Amount | 126081.71 |
| Total Medicare Standardized Payment Amount | 115291.34 |
| 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 | 75 |
| Number Of Medical Services | 1036 |
| Number Of Medicare Beneficiaries With Medical Services | 526 |
| Total Medical Submitted Charge Amount | 1015370 |
| Total Medical Medicare Allowed Amount | 161311.02 |
| Total Medical Medicare Payment Amount | 126081.71 |
| Total Medical Medicare Standardized Payment Amount | 115291.34 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 230 |
| Number Of Beneficiaries Age 75 to 84 | 182 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 284 |
| Number Of Male Beneficiaries | 242 |
| Number Of Non Hispanic White Beneficiaries | 474 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 444 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 82 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.4516 |