| National Provider Identifier [NPI]: | 1174584908 |
| Last Name Of The Provider | MANI |
| First Name Of The Provider | OBLI |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1250 HANCOCK ST |
| Street Address 2 Of The Provider | INTERNAL MEDICINE |
| City Of The Provider | QUINCY |
| Zip Code Of The Provider | 021694339 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 110 |
| Number Of Services | 1425 |
| Number Of Medicare Beneficiaries | 179 |
| Total Submitted Charge Amount | 64612 |
| Total Medicare Allowed Amount | 50219.18 |
| Total Medicare Payment Amount | 38844.4 |
| Total Medicare Standardized Payment Amount | 37296.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 49 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 1896 |
| Total Drug Medicare AllowedAmount | 1379.83 |
| Total Drug Medicare PaymentAmount | 1345.36 |
| Total Drug Medicare Standardized Payment Amount | 1345.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 98 |
| Number Of Medical Services | 1376 |
| Number Of Medicare Beneficiaries With Medical Services | 179 |
| Total Medical Submitted Charge Amount | 62716 |
| Total Medical Medicare Allowed Amount | 48839.35 |
| Total Medical Medicare Payment Amount | 37499.04 |
| Total Medical Medicare Standardized Payment Amount | 35951.31 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 61 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 127 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | 127 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 79 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 100 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 12 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0986 |