| National Provider Identifier [NPI]: | 1285730804 |
| Last Name Of The Provider | MANANSALA |
| First Name Of The Provider | ARTEMIO |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 111 BREWSTER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PAWTUCKET |
| Zip Code Of The Provider | 028604400 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 115 |
| Number Of Services | 1428 |
| Number Of Medicare Beneficiaries | 1041 |
| Total Submitted Charge Amount | 805783 |
| Total Medicare Allowed Amount | 186899.02 |
| Total Medicare Payment Amount | 142136.54 |
| Total Medicare Standardized Payment Amount | 138142.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 115 |
| Number Of Medical Services | 1428 |
| Number Of Medicare Beneficiaries With Medical Services | 1041 |
| Total Medical Submitted Charge Amount | 805783 |
| Total Medical Medicare Allowed Amount | 186899.02 |
| Total Medical Medicare Payment Amount | 142136.54 |
| Total Medical Medicare Standardized Payment Amount | 138142.16 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 234 |
| Number Of Beneficiaries Age 65 to 74 | 401 |
| Number Of Beneficiaries Age 75 to 84 | 270 |
| Number Of Beneficiaries Age Greater 84 | 136 |
| Number Of Female Beneficiaries | 654 |
| Number Of Male Beneficiaries | 387 |
| Number Of Non Hispanic White Beneficiaries | 898 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 78 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 715 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 326 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.379 |