| National Provider Identifier [NPI]: | 1164426102 |
| Last Name Of The Provider | MANNLEIN |
| First Name Of The Provider | TEPHI |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1120 WELLINGTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND JUNCTION |
| Zip Code Of The Provider | 815016129 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 81 |
| Number Of Services | 1074 |
| Number Of Medicare Beneficiaries | 195 |
| Total Submitted Charge Amount | 85452 |
| Total Medicare Allowed Amount | 39548.12 |
| Total Medicare Payment Amount | 27585.22 |
| Total Medicare Standardized Payment Amount | 32370.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 442 |
| Total Drug Medicare AllowedAmount | 279.29 |
| Total Drug Medicare PaymentAmount | 263.2 |
| Total Drug Medicare Standardized Payment Amount | 263.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 1050 |
| Number Of Medicare Beneficiaries With Medical Services | 195 |
| Total Medical Submitted Charge Amount | 85010 |
| Total Medical Medicare Allowed Amount | 39268.83 |
| Total Medical Medicare Payment Amount | 27322.02 |
| Total Medical Medicare Standardized Payment Amount | 32106.86 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 132 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 181 |
| 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 | 167 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.819 |