| National Provider Identifier [NPI]: | 1821058157 |
| Last Name Of The Provider | MORI |
| First Name Of The Provider | KURT |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3599 UNIVERSITY BLVD S |
| Street Address 2 Of The Provider | BUILDING 300 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322164252 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 260 |
| Number Of Services | 3581 |
| Number Of Medicare Beneficiaries | 2341 |
| Total Submitted Charge Amount | 688923 |
| Total Medicare Allowed Amount | 172532.5 |
| Total Medicare Payment Amount | 133820.49 |
| Total Medicare Standardized Payment Amount | 132734.68 |
| 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 | 260 |
| Number Of Medical Services | 3581 |
| Number Of Medicare Beneficiaries With Medical Services | 2341 |
| Total Medical Submitted Charge Amount | 688923 |
| Total Medical Medicare Allowed Amount | 172532.5 |
| Total Medical Medicare Payment Amount | 133820.49 |
| Total Medical Medicare Standardized Payment Amount | 132734.68 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 414 |
| Number Of Beneficiaries Age 65 to 74 | 827 |
| Number Of Beneficiaries Age 75 to 84 | 702 |
| Number Of Beneficiaries Age Greater 84 | 398 |
| Number Of Female Beneficiaries | 1323 |
| Number Of Male Beneficiaries | 1018 |
| Number Of Non Hispanic White Beneficiaries | 1822 |
| Number Of Black or African American Beneficiaries | 365 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 81 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1728 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 613 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.3978 |