| National Provider Identifier [NPI]: | 1689712408 |
| Last Name Of The Provider | MANZO |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 611 W PARK ST |
| Street Address 2 Of The Provider | RADIOLOGY |
| City Of The Provider | URBANA |
| Zip Code Of The Provider | 618012529 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 130 |
| Number Of Services | 2678 |
| Number Of Medicare Beneficiaries | 1617 |
| Total Submitted Charge Amount | 209818.94 |
| Total Medicare Allowed Amount | 73565.41 |
| Total Medicare Payment Amount | 58080.4 |
| Total Medicare Standardized Payment Amount | 59119.85 |
| 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 | 130 |
| Number Of Medical Services | 2678 |
| Number Of Medicare Beneficiaries With Medical Services | 1617 |
| Total Medical Submitted Charge Amount | 209818.94 |
| Total Medical Medicare Allowed Amount | 73565.41 |
| Total Medical Medicare Payment Amount | 58080.4 |
| Total Medical Medicare Standardized Payment Amount | 59119.85 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 329 |
| Number Of Beneficiaries Age 65 to 74 | 575 |
| Number Of Beneficiaries Age 75 to 84 | 434 |
| Number Of Beneficiaries Age Greater 84 | 279 |
| Number Of Female Beneficiaries | 975 |
| Number Of Male Beneficiaries | 642 |
| Number Of Non Hispanic White Beneficiaries | 1515 |
| Number Of Black or African American Beneficiaries | 57 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1164 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 453 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3777 |