| National Provider Identifier [NPI]: | 1821103698 |
| Last Name Of The Provider | BRENNAN |
| First Name Of The Provider | SEAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1234 E DUPONT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468251545 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 946 |
| Number Of Medicare Beneficiaries | 257 |
| Total Submitted Charge Amount | 123794 |
| Total Medicare Allowed Amount | 62488.22 |
| Total Medicare Payment Amount | 42332.42 |
| Total Medicare Standardized Payment Amount | 45173.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 143 |
| Number Of Medicare Beneficiaries With Drug Services | 90 |
| Total Drug Submitted ChargeAmount | 11404 |
| Total Drug Medicare AllowedAmount | 3751.62 |
| Total Drug Medicare PaymentAmount | 3596.91 |
| Total Drug Medicare Standardized Payment Amount | 3596.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 803 |
| Number Of Medicare Beneficiaries With Medical Services | 257 |
| Total Medical Submitted Charge Amount | 112390 |
| Total Medical Medicare Allowed Amount | 58736.6 |
| Total Medical Medicare Payment Amount | 38735.51 |
| Total Medical Medicare Standardized Payment Amount | 41576.17 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 127 |
| Number Of Beneficiaries Age 75 to 84 | 74 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 132 |
| Number Of Male Beneficiaries | 125 |
| Number Of Non Hispanic White Beneficiaries | 240 |
| 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 | 226 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.8632 |