| National Provider Identifier [NPI]: | 1881651461 |
| Last Name Of The Provider | MANTELL |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 501 N LINCOLN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILO |
| Zip Code Of The Provider | 618649653 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 1572 |
| Number Of Medicare Beneficiaries | 483 |
| Total Submitted Charge Amount | 190784.81 |
| Total Medicare Allowed Amount | 112436.88 |
| Total Medicare Payment Amount | 82329.84 |
| Total Medicare Standardized Payment Amount | 86950.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 61 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 1791 |
| Total Drug Medicare AllowedAmount | 108.38 |
| Total Drug Medicare PaymentAmount | 83.29 |
| Total Drug Medicare Standardized Payment Amount | 83.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 1511 |
| Number Of Medicare Beneficiaries With Medical Services | 483 |
| Total Medical Submitted Charge Amount | 188993.81 |
| Total Medical Medicare Allowed Amount | 112328.5 |
| Total Medical Medicare Payment Amount | 82246.55 |
| Total Medical Medicare Standardized Payment Amount | 86867.05 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 209 |
| Number Of Beneficiaries Age 65 to 74 | 148 |
| Number Of Beneficiaries Age 75 to 84 | 94 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 273 |
| Number Of Male Beneficiaries | 210 |
| Number Of Non Hispanic White Beneficiaries | 398 |
| Number Of Black or African American Beneficiaries | 70 |
| 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 | 257 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 226 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.201 |