| National Provider Identifier [NPI]: | 1659542488 |
| Last Name Of The Provider | MANGRULKAR |
| First Name Of The Provider | VAIBHAV |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8629 SUDLEY RD |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | MANASSAS |
| Zip Code Of The Provider | 201104590 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 162 |
| Number Of Services | 2872 |
| Number Of Medicare Beneficiaries | 1983 |
| Total Submitted Charge Amount | 544773 |
| Total Medicare Allowed Amount | 108277.29 |
| Total Medicare Payment Amount | 79828.51 |
| Total Medicare Standardized Payment Amount | 80276.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 30 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 284 |
| Total Drug Medicare AllowedAmount | 42.64 |
| Total Drug Medicare PaymentAmount | 33.45 |
| Total Drug Medicare Standardized Payment Amount | 33.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 160 |
| Number Of Medical Services | 2842 |
| Number Of Medicare Beneficiaries With Medical Services | 1983 |
| Total Medical Submitted Charge Amount | 544489 |
| Total Medical Medicare Allowed Amount | 108234.65 |
| Total Medical Medicare Payment Amount | 79795.06 |
| Total Medical Medicare Standardized Payment Amount | 80242.66 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 225 |
| Number Of Beneficiaries Age 65 to 74 | 857 |
| Number Of Beneficiaries Age 75 to 84 | 602 |
| Number Of Beneficiaries Age Greater 84 | 299 |
| Number Of Female Beneficiaries | 1232 |
| Number Of Male Beneficiaries | 751 |
| Number Of Non Hispanic White Beneficiaries | 1619 |
| Number Of Black or African American Beneficiaries | 217 |
| Number Of AsianPacific Islander Beneficiaries | 58 |
| Number Of Hispanic Beneficiaries | 59 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1644 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 339 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3939 |