| National Provider Identifier [NPI]: | 1114922309 |
| Last Name Of The Provider | HENNESSY |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 51-53 KENOSIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DANBURY |
| Zip Code Of The Provider | 068104015 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 4934 |
| Number Of Medicare Beneficiaries | 1089 |
| Total Submitted Charge Amount | 830625.6 |
| Total Medicare Allowed Amount | 328595.76 |
| Total Medicare Payment Amount | 240508.06 |
| Total Medicare Standardized Payment Amount | 228546.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 682 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 156767.6 |
| Total Drug Medicare AllowedAmount | 52474.51 |
| Total Drug Medicare PaymentAmount | 40318.63 |
| Total Drug Medicare Standardized Payment Amount | 40318.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 4252 |
| Number Of Medicare Beneficiaries With Medical Services | 1089 |
| Total Medical Submitted Charge Amount | 673858 |
| Total Medical Medicare Allowed Amount | 276121.25 |
| Total Medical Medicare Payment Amount | 200189.43 |
| Total Medical Medicare Standardized Payment Amount | 188227.8 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 441 |
| Number Of Beneficiaries Age 75 to 84 | 386 |
| Number Of Beneficiaries Age Greater 84 | 199 |
| Number Of Female Beneficiaries | 157 |
| Number Of Male Beneficiaries | 932 |
| Number Of Non Hispanic White Beneficiaries | 998 |
| Number Of Black or African American Beneficiaries | 19 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 944 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 145 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 26 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3004 |