| National Provider Identifier [NPI]: | 1316946650 |
| Last Name Of The Provider | CONNELLY |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 465 SE RIVERSIDE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | STUART |
| Zip Code Of The Provider | 349942584 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 5481 |
| Number Of Medicare Beneficiaries | 587 |
| Total Submitted Charge Amount | 1031199.66 |
| Total Medicare Allowed Amount | 682030.21 |
| Total Medicare Payment Amount | 518211.13 |
| Total Medicare Standardized Payment Amount | 483428.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 147 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 9863.66 |
| Total Drug Medicare AllowedAmount | 9762.27 |
| Total Drug Medicare PaymentAmount | 7620.76 |
| Total Drug Medicare Standardized Payment Amount | 7620.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 89 |
| Number Of Medical Services | 5334 |
| Number Of Medicare Beneficiaries With Medical Services | 587 |
| Total Medical Submitted Charge Amount | 1021336 |
| Total Medical Medicare Allowed Amount | 672267.94 |
| Total Medical Medicare Payment Amount | 510590.37 |
| Total Medical Medicare Standardized Payment Amount | 475808 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 193 |
| Number Of Beneficiaries Age 75 to 84 | 266 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 271 |
| Number Of Male Beneficiaries | 316 |
| Number Of Non Hispanic White Beneficiaries | 575 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 576 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.007 |