| National Provider Identifier [NPI]: | 1891764676 |
| Last Name Of The Provider | CONCANNON |
| First Name Of The Provider | CRAIG |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1005 N LINCOLN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BELOIT |
| Zip Code Of The Provider | 674201215 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 210 |
| Number Of Services | 16007 |
| Number Of Medicare Beneficiaries | 982 |
| Total Submitted Charge Amount | 984541.74 |
| Total Medicare Allowed Amount | 449736.35 |
| Total Medicare Payment Amount | 350820.01 |
| Total Medicare Standardized Payment Amount | 366052.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 5331 |
| Number Of Medicare Beneficiaries With Drug Services | 335 |
| Total Drug Submitted ChargeAmount | 140292 |
| Total Drug Medicare AllowedAmount | 90744.57 |
| Total Drug Medicare PaymentAmount | 79256.57 |
| Total Drug Medicare Standardized Payment Amount | 79256.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 193 |
| Number Of Medical Services | 10676 |
| Number Of Medicare Beneficiaries With Medical Services | 982 |
| Total Medical Submitted Charge Amount | 844249.74 |
| Total Medical Medicare Allowed Amount | 358991.78 |
| Total Medical Medicare Payment Amount | 271563.44 |
| Total Medical Medicare Standardized Payment Amount | 286795.54 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 56 |
| Number Of Beneficiaries Age 65 to 74 | 298 |
| Number Of Beneficiaries Age 75 to 84 | 365 |
| Number Of Beneficiaries Age Greater 84 | 263 |
| Number Of Female Beneficiaries | 512 |
| Number Of Male Beneficiaries | 470 |
| Number Of Non Hispanic White Beneficiaries | 969 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 799 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 183 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 23 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1867 |