| National Provider Identifier [NPI]: | 1750369419 |
| Last Name Of The Provider | CONNOLLY |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 520 VALLEY VIEW DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOLINE |
| Zip Code Of The Provider | 612656194 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 140 |
| Number Of Services | 6482 |
| Number Of Medicare Beneficiaries | 863 |
| Total Submitted Charge Amount | 1919640 |
| Total Medicare Allowed Amount | 543056.77 |
| Total Medicare Payment Amount | 411071.54 |
| Total Medicare Standardized Payment Amount | 412870.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 631 |
| Number Of Medicare Beneficiaries With Drug Services | 254 |
| Total Drug Submitted ChargeAmount | 39689 |
| Total Drug Medicare AllowedAmount | 20877.52 |
| Total Drug Medicare PaymentAmount | 16051.92 |
| Total Drug Medicare Standardized Payment Amount | 16051.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 135 |
| Number Of Medical Services | 5851 |
| Number Of Medicare Beneficiaries With Medical Services | 863 |
| Total Medical Submitted Charge Amount | 1879951 |
| Total Medical Medicare Allowed Amount | 522179.25 |
| Total Medical Medicare Payment Amount | 395019.62 |
| Total Medical Medicare Standardized Payment Amount | 396818.98 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 383 |
| Number Of Beneficiaries Age 75 to 84 | 282 |
| Number Of Beneficiaries Age Greater 84 | 138 |
| Number Of Female Beneficiaries | 521 |
| Number Of Male Beneficiaries | 342 |
| Number Of Non Hispanic White Beneficiaries | 812 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 789 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 74 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 73 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.0328 |