| National Provider Identifier [NPI]: | 1619014230 |
| Last Name Of The Provider | MOON |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5348 CARROLL CANYON RD |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921211733 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 4304 |
| Number Of Medicare Beneficiaries | 202 |
| Total Submitted Charge Amount | 351560 |
| Total Medicare Allowed Amount | 161128.75 |
| Total Medicare Payment Amount | 122167.72 |
| Total Medicare Standardized Payment Amount | 90771.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 55 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 995 |
| Total Drug Medicare AllowedAmount | 18.3 |
| Total Drug Medicare PaymentAmount | 14.35 |
| Total Drug Medicare Standardized Payment Amount | 14.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 4249 |
| Number Of Medicare Beneficiaries With Medical Services | 202 |
| Total Medical Submitted Charge Amount | 350565 |
| Total Medical Medicare Allowed Amount | 161110.45 |
| Total Medical Medicare Payment Amount | 122153.37 |
| Total Medical Medicare Standardized Payment Amount | 90757.62 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 121 |
| Number Of Male Beneficiaries | 81 |
| Number Of Non Hispanic White Beneficiaries | 167 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 163 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 44 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2098 |