| National Provider Identifier [NPI]: | 1336242114 |
| Last Name Of The Provider | MAININI |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 201 YELLOWSTONE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CODY |
| Zip Code Of The Provider | 824149313 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 3568 |
| Number Of Medicare Beneficiaries | 795 |
| Total Submitted Charge Amount | 431736.6 |
| Total Medicare Allowed Amount | 197333.22 |
| Total Medicare Payment Amount | 144782.43 |
| Total Medicare Standardized Payment Amount | 144341.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 153 |
| Number Of Medicare Beneficiaries With Drug Services | 79 |
| Total Drug Submitted ChargeAmount | 6507.6 |
| Total Drug Medicare AllowedAmount | 4062.22 |
| Total Drug Medicare PaymentAmount | 3803.69 |
| Total Drug Medicare Standardized Payment Amount | 3803.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 3415 |
| Number Of Medicare Beneficiaries With Medical Services | 791 |
| Total Medical Submitted Charge Amount | 425229 |
| Total Medical Medicare Allowed Amount | 193271 |
| Total Medical Medicare Payment Amount | 140978.74 |
| Total Medical Medicare Standardized Payment Amount | 140537.62 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 105 |
| Number Of Beneficiaries Age 65 to 74 | 366 |
| Number Of Beneficiaries Age 75 to 84 | 246 |
| Number Of Beneficiaries Age Greater 84 | 78 |
| Number Of Female Beneficiaries | 395 |
| Number Of Male Beneficiaries | 400 |
| Number Of Non Hispanic White Beneficiaries | 766 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 700 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 95 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1121 |