National Provider Identifier [NPI]: |
1447279716 |
Last Name Of The Provider |
MOORE |
First Name Of The Provider |
CRAIG |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3264 N EVERGREEN DR NE |
Street Address 2 Of The Provider |
|
City Of The Provider |
GRAND RAPIDS |
Zip Code Of The Provider |
495259746 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
150 |
Number Of Services |
4179 |
Number Of Medicare Beneficiaries |
3134 |
Total Submitted Charge Amount |
527453 |
Total Medicare Allowed Amount |
139169.2 |
Total Medicare Payment Amount |
104567.1 |
Total Medicare Standardized Payment Amount |
107584.49 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
150 |
Number Of Medical Services |
4179 |
Number Of Medicare Beneficiaries With Medical Services |
3134 |
Total Medical Submitted Charge Amount |
527453 |
Total Medical Medicare Allowed Amount |
139169.2 |
Total Medical Medicare Payment Amount |
104567.1 |
Total Medical Medicare Standardized Payment Amount |
107584.49 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
785 |
Number Of Beneficiaries Age 65 to 74 |
996 |
Number Of Beneficiaries Age 75 to 84 |
869 |
Number Of Beneficiaries Age Greater 84 |
484 |
Number Of Female Beneficiaries |
1800 |
Number Of Male Beneficiaries |
1334 |
Number Of Non Hispanic White Beneficiaries |
2745 |
Number Of Black or African American Beneficiaries |
242 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
79 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
44 |
Number Of Beneficiaries With Medicare Only Entitlement |
2165 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
969 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
33 |
Percent Of With Chronic Kidney Disease |
40 |
Percent Of With Chronic Obstructive Pulmonary Disease |
30 |
Percent Of With Depression |
38 |
Percent Of With Diabetes |
37 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
52 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.8363 |