| National Provider Identifier [NPI]: | 1760430102 |
| Last Name Of The Provider | KEENAN |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1776 BOSTON TPKE |
| Street Address 2 Of The Provider | |
| City Of The Provider | COVENTRY |
| Zip Code Of The Provider | 062381160 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 110 |
| Number Of Services | 3507 |
| Number Of Medicare Beneficiaries | 660 |
| Total Submitted Charge Amount | 461169.63 |
| Total Medicare Allowed Amount | 222027.76 |
| Total Medicare Payment Amount | 168690.41 |
| Total Medicare Standardized Payment Amount | 159028.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 417 |
| Number Of Medicare Beneficiaries With Drug Services | 248 |
| Total Drug Submitted ChargeAmount | 22797 |
| Total Drug Medicare AllowedAmount | 12196.3 |
| Total Drug Medicare PaymentAmount | 11868.03 |
| Total Drug Medicare Standardized Payment Amount | 11868.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 95 |
| Number Of Medical Services | 3090 |
| Number Of Medicare Beneficiaries With Medical Services | 660 |
| Total Medical Submitted Charge Amount | 438372.63 |
| Total Medical Medicare Allowed Amount | 209831.46 |
| Total Medical Medicare Payment Amount | 156822.38 |
| Total Medical Medicare Standardized Payment Amount | 147160.43 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 136 |
| Number Of Beneficiaries Age 65 to 74 | 237 |
| Number Of Beneficiaries Age 75 to 84 | 195 |
| Number Of Beneficiaries Age Greater 84 | 92 |
| Number Of Female Beneficiaries | 312 |
| Number Of Male Beneficiaries | 348 |
| Number Of Non Hispanic White Beneficiaries | 609 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 455 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 205 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2867 |