| National Provider Identifier [NPI]: | 1326009861 |
| Last Name Of The Provider | MANSOUR |
| First Name Of The Provider | SABRY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 25 MILLVILLE ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAPEER |
| Zip Code Of The Provider | 48446 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 107 |
| Number Of Services | 5837 |
| Number Of Medicare Beneficiaries | 624 |
| Total Submitted Charge Amount | 812661 |
| Total Medicare Allowed Amount | 334224.87 |
| Total Medicare Payment Amount | 250728 |
| Total Medicare Standardized Payment Amount | 260581.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 2601 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 171660 |
| Total Drug Medicare AllowedAmount | 60888.03 |
| Total Drug Medicare PaymentAmount | 46382.03 |
| Total Drug Medicare Standardized Payment Amount | 46382.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 101 |
| Number Of Medical Services | 3236 |
| Number Of Medicare Beneficiaries With Medical Services | 624 |
| Total Medical Submitted Charge Amount | 641001 |
| Total Medical Medicare Allowed Amount | 273336.84 |
| Total Medical Medicare Payment Amount | 204345.97 |
| Total Medical Medicare Standardized Payment Amount | 214199.17 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 89 |
| Number Of Beneficiaries Age 65 to 74 | 260 |
| Number Of Beneficiaries Age 75 to 84 | 205 |
| Number Of Beneficiaries Age Greater 84 | 70 |
| Number Of Female Beneficiaries | 205 |
| Number Of Male Beneficiaries | 419 |
| Number Of Non Hispanic White Beneficiaries | 604 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 511 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 113 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6889 |