National Provider Identifier [NPI]: |
1356325369 |
Last Name Of The Provider |
MOORE |
First Name Of The Provider |
POLLY |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5330 E STOP 11 RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
INDIANAPOLIS |
Zip Code Of The Provider |
462376345 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Cardiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
37 |
Number Of Services |
2878 |
Number Of Medicare Beneficiaries |
1201 |
Total Submitted Charge Amount |
387819 |
Total Medicare Allowed Amount |
169435.54 |
Total Medicare Payment Amount |
124221.18 |
Total Medicare Standardized Payment Amount |
130338.94 |
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 |
37 |
Number Of Medical Services |
2878 |
Number Of Medicare Beneficiaries With Medical Services |
1201 |
Total Medical Submitted Charge Amount |
387819 |
Total Medical Medicare Allowed Amount |
169435.54 |
Total Medical Medicare Payment Amount |
124221.18 |
Total Medical Medicare Standardized Payment Amount |
130338.94 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
135 |
Number Of Beneficiaries Age 65 to 74 |
496 |
Number Of Beneficiaries Age 75 to 84 |
396 |
Number Of Beneficiaries Age Greater 84 |
174 |
Number Of Female Beneficiaries |
709 |
Number Of Male Beneficiaries |
492 |
Number Of Non Hispanic White Beneficiaries |
1174 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
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 |
1006 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
195 |
Percent Of With Atrial Fibrillation |
31 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
41 |
Percent Of With Chronic Kidney Disease |
42 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
68 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.5319 |