| National Provider Identifier [NPI]: | 1548486947 |
| Last Name Of The Provider | NWAIGWE |
| First Name Of The Provider | MANASSEH |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1159 S. LORENA ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 90023 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 6 |
| Number Of Services | 82 |
| Number Of Medicare Beneficiaries | 18 |
| Total Submitted Charge Amount | 8180 |
| Total Medicare Allowed Amount | 3282.54 |
| Total Medicare Payment Amount | 2573.63 |
| Total Medicare Standardized Payment Amount | 2596.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 5690 |
| Total Drug Medicare AllowedAmount | 1206.42 |
| Total Drug Medicare PaymentAmount | 945.95 |
| Total Drug Medicare Standardized Payment Amount | 945.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 3 |
| Number Of Medical Services | 36 |
| Number Of Medicare Beneficiaries With Medical Services | 18 |
| Total Medical Submitted Charge Amount | 2490 |
| Total Medical Medicare Allowed Amount | 2076.12 |
| Total Medical Medicare Payment Amount | 1627.68 |
| Total Medical Medicare Standardized Payment Amount | 1651.04 |
| Average Age Of Beneficiaries | 56 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 0 |
| 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 | |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 67 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.2587 |