| National Provider Identifier [NPI]: | 1396852497 |
| Last Name Of The Provider | MANCUSO |
| First Name Of The Provider | MARTIN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7100 W CENTER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681062700 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 6715 |
| Number Of Medicare Beneficiaries | 696 |
| Total Submitted Charge Amount | 454571 |
| Total Medicare Allowed Amount | 216503.31 |
| Total Medicare Payment Amount | 158206.12 |
| Total Medicare Standardized Payment Amount | 171321.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 818 |
| Number Of Medicare Beneficiaries With Drug Services | 230 |
| Total Drug Submitted ChargeAmount | 15090 |
| Total Drug Medicare AllowedAmount | 8034.77 |
| Total Drug Medicare PaymentAmount | 7257.38 |
| Total Drug Medicare Standardized Payment Amount | 7257.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 65 |
| Number Of Medical Services | 5897 |
| Number Of Medicare Beneficiaries With Medical Services | 696 |
| Total Medical Submitted Charge Amount | 439481 |
| Total Medical Medicare Allowed Amount | 208468.54 |
| Total Medical Medicare Payment Amount | 150948.74 |
| Total Medical Medicare Standardized Payment Amount | 164064.37 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 286 |
| Number Of Beneficiaries Age 75 to 84 | 248 |
| Number Of Beneficiaries Age Greater 84 | 122 |
| Number Of Female Beneficiaries | 376 |
| Number Of Male Beneficiaries | 320 |
| Number Of Non Hispanic White Beneficiaries | 660 |
| Number Of Black or African American Beneficiaries | 14 |
| 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 | 660 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.032 |