CMS138v4 has IPP that requires at least two visits or at least one preventive visit during the measurement period.

Patient 1 N GP Adult has two encounters with the same id. These encounters are not the typical "cypress duplicates" in that their codes differ.

Because the encounters have the same id the second one is never considered for evaluation. The encounter not considered for evaluation by itself would meet the "at least one preventive visit". This causes the patient to not meet the IPP.