| National Provider Identifier [NPI]: | 1508828344 |
| Last Name Of The Provider | MANSUR |
| First Name Of The Provider | IZZUDDIN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 49 CLEVELAND ST |
| Street Address 2 Of The Provider | SUITE 220 |
| City Of The Provider | CROSSVILLE |
| Zip Code Of The Provider | 385552855 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 5720 |
| Number Of Medicare Beneficiaries | 1409 |
| Total Submitted Charge Amount | 960481.08 |
| Total Medicare Allowed Amount | 491452.99 |
| Total Medicare Payment Amount | 356546.46 |
| Total Medicare Standardized Payment Amount | 383965.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 288 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 63478.08 |
| Total Drug Medicare AllowedAmount | 61797.41 |
| Total Drug Medicare PaymentAmount | 46929.22 |
| Total Drug Medicare Standardized Payment Amount | 46929.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 5432 |
| Number Of Medicare Beneficiaries With Medical Services | 1409 |
| Total Medical Submitted Charge Amount | 897003 |
| Total Medical Medicare Allowed Amount | 429655.58 |
| Total Medical Medicare Payment Amount | 309617.24 |
| Total Medical Medicare Standardized Payment Amount | 337036.46 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 562 |
| Number Of Beneficiaries Age 75 to 84 | 560 |
| Number Of Beneficiaries Age Greater 84 | 191 |
| Number Of Female Beneficiaries | 376 |
| Number Of Male Beneficiaries | 1033 |
| Number Of Non Hispanic White Beneficiaries | 1380 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1216 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 193 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2156 |