| National Provider Identifier [NPI]: | 1104899913 |
| Last Name Of The Provider | MANN |
| First Name Of The Provider | DEAN |
| 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 | 640 JACKSON ST |
| Street Address 2 Of The Provider | MC 11503B |
| City Of The Provider | SAINT PAUL |
| Zip Code Of The Provider | 551012502 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Plastic and Reconstructive Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 287 |
| Number Of Medicare Beneficiaries | 100 |
| Total Submitted Charge Amount | 200068 |
| Total Medicare Allowed Amount | 52935.48 |
| Total Medicare Payment Amount | 40973.2 |
| Total Medicare Standardized Payment Amount | 40382.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 39 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 278 |
| Total Drug Medicare AllowedAmount | 109.48 |
| Total Drug Medicare PaymentAmount | 83.51 |
| Total Drug Medicare Standardized Payment Amount | 83.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 248 |
| Number Of Medicare Beneficiaries With Medical Services | 100 |
| Total Medical Submitted Charge Amount | 199790 |
| Total Medical Medicare Allowed Amount | 52826 |
| Total Medical Medicare Payment Amount | 40889.69 |
| Total Medical Medicare Standardized Payment Amount | 40299.38 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 27 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 62 |
| Number Of Male Beneficiaries | 38 |
| Number Of Non Hispanic White Beneficiaries | 77 |
| 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 | 47 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 53 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3824 |