| National Provider Identifier [NPI]: | 1881658490 |
| Last Name Of The Provider | MANTLE |
| First Name Of The Provider | JOHN |
| 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 | 701 UNIVERSITY BLVD E |
| Street Address 2 Of The Provider | SUITE 400 |
| City Of The Provider | TUSCALOOSA |
| Zip Code Of The Provider | 35401 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 3557 |
| Number Of Medicare Beneficiaries | 1221 |
| Total Submitted Charge Amount | 341956 |
| Total Medicare Allowed Amount | 258642.89 |
| Total Medicare Payment Amount | 175530.65 |
| Total Medicare Standardized Payment Amount | 195463.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 210 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 3536 |
| Total Drug Medicare AllowedAmount | 2593.03 |
| Total Drug Medicare PaymentAmount | 2033.04 |
| Total Drug Medicare Standardized Payment Amount | 2033.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 3347 |
| Number Of Medicare Beneficiaries With Medical Services | 1221 |
| Total Medical Submitted Charge Amount | 338420 |
| Total Medical Medicare Allowed Amount | 256049.86 |
| Total Medical Medicare Payment Amount | 173497.61 |
| Total Medical Medicare Standardized Payment Amount | 193430.72 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 179 |
| Number Of Beneficiaries Age 65 to 74 | 428 |
| Number Of Beneficiaries Age 75 to 84 | 414 |
| Number Of Beneficiaries Age Greater 84 | 200 |
| Number Of Female Beneficiaries | 668 |
| Number Of Male Beneficiaries | 553 |
| Number Of Non Hispanic White Beneficiaries | 869 |
| 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 | 949 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 272 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.277 |