| National Provider Identifier [NPI]: | 1710055322 |
| Last Name Of The Provider | MANGUM |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9900 SW HALL BLVD |
| Street Address 2 Of The Provider | #200 |
| City Of The Provider | TIGARD |
| Zip Code Of The Provider | 97223 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 340 |
| Number Of Medicare Beneficiaries | 116 |
| Total Submitted Charge Amount | 29832.7 |
| Total Medicare Allowed Amount | 25308.87 |
| Total Medicare Payment Amount | 16399.18 |
| Total Medicare Standardized Payment Amount | 17608.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 33 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 391.1 |
| Total Drug Medicare AllowedAmount | 363.73 |
| Total Drug Medicare PaymentAmount | 351.44 |
| Total Drug Medicare Standardized Payment Amount | 351.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 307 |
| Number Of Medicare Beneficiaries With Medical Services | 116 |
| Total Medical Submitted Charge Amount | 29441.6 |
| Total Medical Medicare Allowed Amount | 24945.14 |
| Total Medical Medicare Payment Amount | 16047.74 |
| Total Medical Medicare Standardized Payment Amount | 17257.31 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 53 |
| Number Of Male Beneficiaries | 63 |
| 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 | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.875 |