| National Provider Identifier [NPI]: | 1346225406 |
| Last Name Of The Provider | MOSS |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5901 TECHNOLOGY CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462786013 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 108 |
| Number Of Services | 6788 |
| Number Of Medicare Beneficiaries | 4350 |
| Total Submitted Charge Amount | 413458 |
| Total Medicare Allowed Amount | 145636.32 |
| Total Medicare Payment Amount | 122641.44 |
| Total Medicare Standardized Payment Amount | 128364.84 |
| 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 | 108 |
| Number Of Medical Services | 6788 |
| Number Of Medicare Beneficiaries With Medical Services | 4350 |
| Total Medical Submitted Charge Amount | 413458 |
| Total Medical Medicare Allowed Amount | 145636.32 |
| Total Medical Medicare Payment Amount | 122641.44 |
| Total Medical Medicare Standardized Payment Amount | 128364.84 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 611 |
| Number Of Beneficiaries Age 65 to 74 | 1992 |
| Number Of Beneficiaries Age 75 to 84 | 1244 |
| Number Of Beneficiaries Age Greater 84 | 503 |
| Number Of Female Beneficiaries | 3453 |
| Number Of Male Beneficiaries | 897 |
| Number Of Non Hispanic White Beneficiaries | 3890 |
| Number Of Black or African American Beneficiaries | 367 |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3564 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 786 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2868 |