| National Provider Identifier [NPI]: | 1093799587 |
| Last Name Of The Provider | MAENNLE |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7733 E JEFFERSON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 482143707 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 1890 |
| Number Of Medicare Beneficiaries | 777 |
| Total Submitted Charge Amount | 251746 |
| Total Medicare Allowed Amount | 62438.83 |
| Total Medicare Payment Amount | 48419.56 |
| Total Medicare Standardized Payment Amount | 38143.64 |
| 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 | 27 |
| Number Of Medical Services | 1890 |
| Number Of Medicare Beneficiaries With Medical Services | 777 |
| Total Medical Submitted Charge Amount | 251746 |
| Total Medical Medicare Allowed Amount | 62438.83 |
| Total Medical Medicare Payment Amount | 48419.56 |
| Total Medical Medicare Standardized Payment Amount | 38143.64 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 154 |
| Number Of Beneficiaries Age 65 to 74 | 262 |
| Number Of Beneficiaries Age 75 to 84 | 238 |
| Number Of Beneficiaries Age Greater 84 | 123 |
| Number Of Female Beneficiaries | 427 |
| Number Of Male Beneficiaries | 350 |
| Number Of Non Hispanic White Beneficiaries | 611 |
| Number Of Black or African American Beneficiaries | 140 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| 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 | 574 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 203 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.2421 |