| National Provider Identifier [NPI]: | 1568547800 |
| Last Name Of The Provider | MOEN |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1001 FOURTH AVE PLAZA, STE 420 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SEATTLE |
| Zip Code Of The Provider | 98154 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 1154 |
| Number Of Medicare Beneficiaries | 174 |
| Total Submitted Charge Amount | 176479 |
| Total Medicare Allowed Amount | 71900.23 |
| Total Medicare Payment Amount | 50337.48 |
| Total Medicare Standardized Payment Amount | 47659.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 19 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 1393 |
| Total Drug Medicare AllowedAmount | 1090.55 |
| Total Drug Medicare PaymentAmount | 1063.65 |
| Total Drug Medicare Standardized Payment Amount | 1063.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 1135 |
| Number Of Medicare Beneficiaries With Medical Services | 174 |
| Total Medical Submitted Charge Amount | 175086 |
| Total Medical Medicare Allowed Amount | 70809.68 |
| Total Medical Medicare Payment Amount | 49273.83 |
| Total Medical Medicare Standardized Payment Amount | 46595.65 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 82 |
| Number Of Beneficiaries Age 75 to 84 | 48 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 77 |
| Number Of Male Beneficiaries | 97 |
| Number Of Non Hispanic White Beneficiaries | 115 |
| Number Of Black or African American Beneficiaries | 33 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 148 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 21 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9708 |