| National Provider Identifier [NPI]: | 1306956024 |
| Last Name Of The Provider | MANNIX |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PT |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2760 N GRANDVIEW AVE |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | ODESSA |
| Zip Code Of The Provider | 797626953 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Therapist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 15185 |
| Number Of Medicare Beneficiaries | 206 |
| Total Submitted Charge Amount | 969258 |
| Total Medicare Allowed Amount | 351935.97 |
| Total Medicare Payment Amount | 268693.19 |
| Total Medicare Standardized Payment Amount | 245251.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 15185 |
| Number Of Medicare Beneficiaries With Medical Services | 206 |
| Total Medical Submitted Charge Amount | 969258 |
| Total Medical Medicare Allowed Amount | 351935.97 |
| Total Medical Medicare Payment Amount | 268693.19 |
| Total Medical Medicare Standardized Payment Amount | 245251.61 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 71 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 134 |
| Number Of Male Beneficiaries | 72 |
| Number Of Non Hispanic White Beneficiaries | 152 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 43 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 170 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 66 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0561 |