| National Provider Identifier [NPI]: | 1497751499 |
| Last Name Of The Provider | MANGER |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 263 FARMINGTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FARMINGTON |
| Zip Code Of The Provider | 060300001 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 855 |
| Number Of Medicare Beneficiaries | 267 |
| Total Submitted Charge Amount | 119209 |
| Total Medicare Allowed Amount | 63163.23 |
| Total Medicare Payment Amount | 43992.36 |
| Total Medicare Standardized Payment Amount | 41382.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 94 |
| Number Of Medicare Beneficiaries With Drug Services | 81 |
| Total Drug Submitted ChargeAmount | 3064 |
| Total Drug Medicare AllowedAmount | 1413.52 |
| Total Drug Medicare PaymentAmount | 1372.47 |
| Total Drug Medicare Standardized Payment Amount | 1372.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 761 |
| Number Of Medicare Beneficiaries With Medical Services | 267 |
| Total Medical Submitted Charge Amount | 116145 |
| Total Medical Medicare Allowed Amount | 61749.71 |
| Total Medical Medicare Payment Amount | 42619.89 |
| Total Medical Medicare Standardized Payment Amount | 40009.67 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 105 |
| Number Of Beneficiaries Age 75 to 84 | 74 |
| Number Of Beneficiaries Age Greater 84 | 57 |
| Number Of Female Beneficiaries | 135 |
| Number Of Male Beneficiaries | 132 |
| Number Of Non Hispanic White Beneficiaries | 234 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 205 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1074 |