National Provider Identifier [NPI]: |
1700876505 |
Last Name Of The Provider |
MORAN |
First Name Of The Provider |
THOMAS |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8404 SIEAR TER |
Street Address 2 Of The Provider |
206 |
City Of The Provider |
INDIANAPOLIS |
Zip Code Of The Provider |
462277215 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
12 |
Number Of Services |
1191 |
Number Of Medicare Beneficiaries |
138 |
Total Submitted Charge Amount |
101455 |
Total Medicare Allowed Amount |
79741.1 |
Total Medicare Payment Amount |
55003.42 |
Total Medicare Standardized Payment Amount |
59628.82 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
108 |
Number Of Medicare Beneficiaries With Drug Services |
54 |
Total Drug Submitted ChargeAmount |
1280 |
Total Drug Medicare AllowedAmount |
936.94 |
Total Drug Medicare PaymentAmount |
882.44 |
Total Drug Medicare Standardized Payment Amount |
882.44 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
10 |
Number Of Medical Services |
1083 |
Number Of Medicare Beneficiaries With Medical Services |
138 |
Total Medical Submitted Charge Amount |
100175 |
Total Medical Medicare Allowed Amount |
78804.16 |
Total Medical Medicare Payment Amount |
54120.98 |
Total Medical Medicare Standardized Payment Amount |
58746.38 |
Average Age Of Beneficiaries |
65 |
Number Of Beneficiaries Age Less65 |
64 |
Number Of Beneficiaries Age 65 to 74 |
39 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
84 |
Number Of Male Beneficiaries |
54 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
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 |
74 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
64 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
12 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
39 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
37 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
60 |
Percent Of With Ischemic Heart Disease |
34 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
71 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3515 |