| National Provider Identifier [NPI]: | 1417905092 |
| Last Name Of The Provider | MOORE |
| First Name Of The Provider | NICHOLAS |
| 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 | 1390 KELLY JOHNSON BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLORADO SPRINGS |
| Zip Code Of The Provider | 809203908 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 210 |
| Number Of Services | 6658 |
| Number Of Medicare Beneficiaries | 2120 |
| Total Submitted Charge Amount | 842236.54 |
| Total Medicare Allowed Amount | 292522 |
| Total Medicare Payment Amount | 227174.91 |
| Total Medicare Standardized Payment Amount | 228638.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3372 |
| Number Of Medicare Beneficiaries With Drug Services | 107 |
| Total Drug Submitted ChargeAmount | 3529 |
| Total Drug Medicare AllowedAmount | 2594.21 |
| Total Drug Medicare PaymentAmount | 1986.16 |
| Total Drug Medicare Standardized Payment Amount | 1986.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 208 |
| Number Of Medical Services | 3286 |
| Number Of Medicare Beneficiaries With Medical Services | 2120 |
| Total Medical Submitted Charge Amount | 838707.54 |
| Total Medical Medicare Allowed Amount | 289927.79 |
| Total Medical Medicare Payment Amount | 225188.75 |
| Total Medical Medicare Standardized Payment Amount | 226652.65 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 326 |
| Number Of Beneficiaries Age 65 to 74 | 903 |
| Number Of Beneficiaries Age 75 to 84 | 620 |
| Number Of Beneficiaries Age Greater 84 | 271 |
| Number Of Female Beneficiaries | 1314 |
| Number Of Male Beneficiaries | 806 |
| Number Of Non Hispanic White Beneficiaries | 1864 |
| Number Of Black or African American Beneficiaries | 82 |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 127 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1830 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 290 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3898 |