| National Provider Identifier [NPI]: | 1619048386 |
| Last Name Of The Provider | MODANSKY |
| First Name Of The Provider | MATTHEW |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1570 ISLAND LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | ORANGE PARK |
| Zip Code Of The Provider | 320037453 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 2039 |
| Number Of Medicare Beneficiaries | 480 |
| Total Submitted Charge Amount | 203132 |
| Total Medicare Allowed Amount | 118487.83 |
| Total Medicare Payment Amount | 73506.66 |
| Total Medicare Standardized Payment Amount | 75053.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 67 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 3870 |
| Total Drug Medicare AllowedAmount | 907.3 |
| Total Drug Medicare PaymentAmount | 795.51 |
| Total Drug Medicare Standardized Payment Amount | 795.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 1972 |
| Number Of Medicare Beneficiaries With Medical Services | 480 |
| Total Medical Submitted Charge Amount | 199262 |
| Total Medical Medicare Allowed Amount | 117580.53 |
| Total Medical Medicare Payment Amount | 72711.15 |
| Total Medical Medicare Standardized Payment Amount | 74257.5 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 84 |
| Number Of Beneficiaries Age 65 to 74 | 237 |
| Number Of Beneficiaries Age 75 to 84 | 110 |
| Number Of Beneficiaries Age Greater 84 | 49 |
| Number Of Female Beneficiaries | 266 |
| Number Of Male Beneficiaries | 214 |
| Number Of Non Hispanic White Beneficiaries | 445 |
| Number Of Black or African American Beneficiaries | 19 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 384 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 96 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1413 |