| National Provider Identifier [NPI]: | 1720085525 |
| Last Name Of The Provider | MANSILLA |
| First Name Of The Provider | ALBERTO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 601 E ROLLINS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ORLANDO |
| Zip Code Of The Provider | 328031248 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 239 |
| Number Of Services | 5212 |
| Number Of Medicare Beneficiaries | 2443 |
| Total Submitted Charge Amount | 629956 |
| Total Medicare Allowed Amount | 202789.5 |
| Total Medicare Payment Amount | 158862.18 |
| Total Medicare Standardized Payment Amount | 157825.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1390 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 676.9 |
| Total Drug Medicare AllowedAmount | 294.24 |
| Total Drug Medicare PaymentAmount | 230.64 |
| Total Drug Medicare Standardized Payment Amount | 230.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 237 |
| Number Of Medical Services | 3822 |
| Number Of Medicare Beneficiaries With Medical Services | 2442 |
| Total Medical Submitted Charge Amount | 629279.1 |
| Total Medical Medicare Allowed Amount | 202495.26 |
| Total Medical Medicare Payment Amount | 158631.54 |
| Total Medical Medicare Standardized Payment Amount | 157594.88 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 635 |
| Number Of Beneficiaries Age 65 to 74 | 836 |
| Number Of Beneficiaries Age 75 to 84 | 648 |
| Number Of Beneficiaries Age Greater 84 | 324 |
| Number Of Female Beneficiaries | 1396 |
| Number Of Male Beneficiaries | 1047 |
| Number Of Non Hispanic White Beneficiaries | 1706 |
| Number Of Black or African American Beneficiaries | 295 |
| Number Of AsianPacific Islander Beneficiaries | 39 |
| Number Of Hispanic Beneficiaries | 368 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1651 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 792 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.4332 |