| National Provider Identifier [NPI]: | 1427032606 |
| Last Name Of The Provider | MANSELL |
| First Name Of The Provider | ERIC |
| 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 | 1317 N ELM ST |
| Street Address 2 Of The Provider | SUITE 1B |
| City Of The Provider | GREENSBORO |
| Zip Code Of The Provider | 274011023 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 105 |
| Number Of Services | 5458 |
| Number Of Medicare Beneficiaries | 1395 |
| Total Submitted Charge Amount | 320465.74 |
| Total Medicare Allowed Amount | 84669.48 |
| Total Medicare Payment Amount | 61937.02 |
| Total Medicare Standardized Payment Amount | 65992.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 3720 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 2751.74 |
| Total Drug Medicare AllowedAmount | 1023.36 |
| Total Drug Medicare PaymentAmount | 735.57 |
| Total Drug Medicare Standardized Payment Amount | 735.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 101 |
| Number Of Medical Services | 1738 |
| Number Of Medicare Beneficiaries With Medical Services | 1395 |
| Total Medical Submitted Charge Amount | 317714 |
| Total Medical Medicare Allowed Amount | 83646.12 |
| Total Medical Medicare Payment Amount | 61201.45 |
| Total Medical Medicare Standardized Payment Amount | 65256.61 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 299 |
| Number Of Beneficiaries Age 65 to 74 | 505 |
| Number Of Beneficiaries Age 75 to 84 | 363 |
| Number Of Beneficiaries Age Greater 84 | 228 |
| Number Of Female Beneficiaries | 808 |
| Number Of Male Beneficiaries | 587 |
| Number Of Non Hispanic White Beneficiaries | 1074 |
| Number Of Black or African American Beneficiaries | 286 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 971 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 424 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.9259 |