| National Provider Identifier [NPI]: | 1174730071 |
| Last Name Of The Provider | MANSFIELD |
| First Name Of The Provider | MYCAL |
| 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 | 104 NICHOLAS PL |
| Street Address 2 Of The Provider | |
| City Of The Provider | AVILLA |
| Zip Code Of The Provider | 467100069 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 1479 |
| Number Of Medicare Beneficiaries | 338 |
| Total Submitted Charge Amount | 186642.8 |
| Total Medicare Allowed Amount | 95102.71 |
| Total Medicare Payment Amount | 62985.71 |
| Total Medicare Standardized Payment Amount | 67588.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 311 |
| Number Of Medicare Beneficiaries With Drug Services | 86 |
| Total Drug Submitted ChargeAmount | 22261.8 |
| Total Drug Medicare AllowedAmount | 6084.39 |
| Total Drug Medicare PaymentAmount | 5305.34 |
| Total Drug Medicare Standardized Payment Amount | 5305.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 1168 |
| Number Of Medicare Beneficiaries With Medical Services | 338 |
| Total Medical Submitted Charge Amount | 164381 |
| Total Medical Medicare Allowed Amount | 89018.32 |
| Total Medical Medicare Payment Amount | 57680.37 |
| Total Medical Medicare Standardized Payment Amount | 62282.74 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 123 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 105 |
| Number Of Female Beneficiaries | 236 |
| Number Of Male Beneficiaries | 102 |
| 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 | 242 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1507 |