| National Provider Identifier [NPI]: | 1457334591 |
| Last Name Of The Provider | MCKENNEY |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1471 KEOKUK ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAMILTON |
| Zip Code Of The Provider | 623411135 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 113 |
| Number Of Services | 6710 |
| Number Of Medicare Beneficiaries | 747 |
| Total Submitted Charge Amount | 326055.14 |
| Total Medicare Allowed Amount | 261509.59 |
| Total Medicare Payment Amount | 179552.31 |
| Total Medicare Standardized Payment Amount | 196102.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 304 |
| Number Of Medicare Beneficiaries With Drug Services | 157 |
| Total Drug Submitted ChargeAmount | 2661.58 |
| Total Drug Medicare AllowedAmount | 2456.63 |
| Total Drug Medicare PaymentAmount | 2305.8 |
| Total Drug Medicare Standardized Payment Amount | 2305.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 104 |
| Number Of Medical Services | 6406 |
| Number Of Medicare Beneficiaries With Medical Services | 747 |
| Total Medical Submitted Charge Amount | 323393.56 |
| Total Medical Medicare Allowed Amount | 259052.96 |
| Total Medical Medicare Payment Amount | 177246.51 |
| Total Medical Medicare Standardized Payment Amount | 193796.93 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 329 |
| Number Of Beneficiaries Age 75 to 84 | 223 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 411 |
| Number Of Male Beneficiaries | 336 |
| Number Of Non Hispanic White Beneficiaries | 725 |
| 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 | 650 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 97 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0202 |