| National Provider Identifier [NPI]: | 1285893594 |
| Last Name Of The Provider | MANTZARIS |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8611 W POINT DOUGLAS RD S |
| Street Address 2 Of The Provider | |
| City Of The Provider | COTTAGE GROVE |
| Zip Code Of The Provider | 550164005 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 937 |
| Number Of Medicare Beneficiaries | 121 |
| Total Submitted Charge Amount | 72213 |
| Total Medicare Allowed Amount | 30708.64 |
| Total Medicare Payment Amount | 22253.54 |
| Total Medicare Standardized Payment Amount | 23177.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 280 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 1052 |
| Total Drug Medicare AllowedAmount | 429.61 |
| Total Drug Medicare PaymentAmount | 376.84 |
| Total Drug Medicare Standardized Payment Amount | 376.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 657 |
| Number Of Medicare Beneficiaries With Medical Services | 120 |
| Total Medical Submitted Charge Amount | 71161 |
| Total Medical Medicare Allowed Amount | 30279.03 |
| Total Medical Medicare Payment Amount | 21876.7 |
| Total Medical Medicare Standardized Payment Amount | 22800.67 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 32 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 58 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 74 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9697 |