| National Provider Identifier [NPI]: | 1487652343 |
| Last Name Of The Provider | MANTIA |
| First Name Of The Provider | PHILIP |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 59 SOUTHERN BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | NESCONSET |
| Zip Code Of The Provider | 117671090 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Gastroenterology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 1457 |
| Number Of Medicare Beneficiaries | 348 |
| Total Submitted Charge Amount | 186604 |
| Total Medicare Allowed Amount | 95715.1 |
| Total Medicare Payment Amount | 70776.42 |
| Total Medicare Standardized Payment Amount | 62023.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 1100 |
| Total Drug Medicare AllowedAmount | 479.85 |
| Total Drug Medicare PaymentAmount | 461.64 |
| Total Drug Medicare Standardized Payment Amount | 461.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 1430 |
| Number Of Medicare Beneficiaries With Medical Services | 347 |
| Total Medical Submitted Charge Amount | 185504 |
| Total Medical Medicare Allowed Amount | 95235.25 |
| Total Medical Medicare Payment Amount | 70314.78 |
| Total Medical Medicare Standardized Payment Amount | 61561.62 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 152 |
| Number Of Beneficiaries Age 75 to 84 | 117 |
| Number Of Beneficiaries Age Greater 84 | 55 |
| Number Of Female Beneficiaries | 170 |
| Number Of Male Beneficiaries | 178 |
| 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 | 316 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.3105 |