| National Provider Identifier [NPI]: | 1407851470 |
| Last Name Of The Provider | HENNEGAN |
| First Name Of The Provider | ENA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1700 W CENTRAL ROAD |
| Street Address 2 Of The Provider | SUITE 140 |
| City Of The Provider | ARLINGTON HEIGHTS |
| Zip Code Of The Provider | 60005 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 999 |
| Number Of Medicare Beneficiaries | 233 |
| Total Submitted Charge Amount | 126234 |
| Total Medicare Allowed Amount | 69210.23 |
| Total Medicare Payment Amount | 50511.62 |
| Total Medicare Standardized Payment Amount | 47689.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 83 |
| Number Of Medicare Beneficiaries With Drug Services | 61 |
| Total Drug Submitted ChargeAmount | 1863 |
| Total Drug Medicare AllowedAmount | 1203.74 |
| Total Drug Medicare PaymentAmount | 1169.54 |
| Total Drug Medicare Standardized Payment Amount | 1169.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 916 |
| Number Of Medicare Beneficiaries With Medical Services | 233 |
| Total Medical Submitted Charge Amount | 124371 |
| Total Medical Medicare Allowed Amount | 68006.49 |
| Total Medical Medicare Payment Amount | 49342.08 |
| Total Medical Medicare Standardized Payment Amount | 46520.35 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 129 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 178 |
| Number Of Male Beneficiaries | 55 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 14 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7944 |