| National Provider Identifier [NPI]: | 1962654392 |
| Last Name Of The Provider | MANALO |
| First Name Of The Provider | SOTARA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2025 E ROUTE 66 |
| Street Address 2 Of The Provider | |
| City Of The Provider | GLENDORA |
| Zip Code Of The Provider | 917404670 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 155 |
| Number Of Medicare Beneficiaries | 43 |
| Total Submitted Charge Amount | 13891 |
| Total Medicare Allowed Amount | 9653.45 |
| Total Medicare Payment Amount | 7432.18 |
| Total Medicare Standardized Payment Amount | 6819.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 688 |
| Total Drug Medicare AllowedAmount | 528.46 |
| Total Drug Medicare PaymentAmount | 517.15 |
| Total Drug Medicare Standardized Payment Amount | 517.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 134 |
| Number Of Medicare Beneficiaries With Medical Services | 43 |
| Total Medical Submitted Charge Amount | 13203 |
| Total Medical Medicare Allowed Amount | 9124.99 |
| Total Medical Medicare Payment Amount | 6915.03 |
| Total Medical Medicare Standardized Payment Amount | 6302.77 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 22 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 29 |
| Number Of Male Beneficiaries | 14 |
| Number Of Non Hispanic White Beneficiaries | 27 |
| 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 | 32 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.9726 |