| National Provider Identifier [NPI]: | 1245220698 |
| Last Name Of The Provider | MANUELIDIS |
| First Name Of The Provider | LAERTES |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8381 RIVERWALK PARK BLVD |
| Street Address 2 Of The Provider | SUITE 1 |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339198760 |
| 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 | 11976 |
| Number Of Medicare Beneficiaries | 1983 |
| Total Submitted Charge Amount | 1604344 |
| Total Medicare Allowed Amount | 1003466.4 |
| Total Medicare Payment Amount | 747900.72 |
| Total Medicare Standardized Payment Amount | 703899.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 115 |
| Number Of Medicare Beneficiaries With Drug Services | 71 |
| Total Drug Submitted ChargeAmount | 10039 |
| Total Drug Medicare AllowedAmount | 8881.55 |
| Total Drug Medicare PaymentAmount | 6689.78 |
| Total Drug Medicare Standardized Payment Amount | 6689.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 89 |
| Number Of Medical Services | 11861 |
| Number Of Medicare Beneficiaries With Medical Services | 1983 |
| Total Medical Submitted Charge Amount | 1594305 |
| Total Medical Medicare Allowed Amount | 994584.85 |
| Total Medical Medicare Payment Amount | 741210.94 |
| Total Medical Medicare Standardized Payment Amount | 697210.15 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 1043 |
| Number Of Beneficiaries Age 75 to 84 | 697 |
| Number Of Beneficiaries Age Greater 84 | 204 |
| Number Of Female Beneficiaries | 979 |
| Number Of Male Beneficiaries | 1004 |
| Number Of Non Hispanic White Beneficiaries | 1905 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1952 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9489 |