| National Provider Identifier [NPI]: | 1669477915 |
| Last Name Of The Provider | MANFREY |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 PRESIDENTIAL BLVD |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | BALA CYNWYD |
| Zip Code Of The Provider | 190041017 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 2638 |
| Number Of Medicare Beneficiaries | 595 |
| Total Submitted Charge Amount | 406923.5 |
| Total Medicare Allowed Amount | 168303.39 |
| Total Medicare Payment Amount | 122128.29 |
| Total Medicare Standardized Payment Amount | 118905.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 288 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 133660 |
| Total Drug Medicare AllowedAmount | 31929.76 |
| Total Drug Medicare PaymentAmount | 24780.46 |
| Total Drug Medicare Standardized Payment Amount | 24780.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 2350 |
| Number Of Medicare Beneficiaries With Medical Services | 595 |
| Total Medical Submitted Charge Amount | 273263.5 |
| Total Medical Medicare Allowed Amount | 136373.63 |
| Total Medical Medicare Payment Amount | 97347.83 |
| Total Medical Medicare Standardized Payment Amount | 94125.15 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 149 |
| Number Of Beneficiaries Age 65 to 74 | 253 |
| Number Of Beneficiaries Age 75 to 84 | 132 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 130 |
| Number Of Male Beneficiaries | 465 |
| Number Of Non Hispanic White Beneficiaries | 373 |
| Number Of Black or African American Beneficiaries | 180 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 362 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 233 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.406 |