| National Provider Identifier [NPI]: | 1194729053 |
| Last Name Of The Provider | MOORE |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 24211 LITTLE MACK AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ST CLAIR SHORES |
| Zip Code Of The Provider | 480801151 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Electrophysiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 2632 |
| Number Of Medicare Beneficiaries | 899 |
| Total Submitted Charge Amount | 562716 |
| Total Medicare Allowed Amount | 360866.86 |
| Total Medicare Payment Amount | 278408.61 |
| Total Medicare Standardized Payment Amount | 266912.16 |
| 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 | 75 |
| Number Of Medical Services | 2632 |
| Number Of Medicare Beneficiaries With Medical Services | 899 |
| Total Medical Submitted Charge Amount | 562716 |
| Total Medical Medicare Allowed Amount | 360866.86 |
| Total Medical Medicare Payment Amount | 278408.61 |
| Total Medical Medicare Standardized Payment Amount | 266912.16 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 135 |
| Number Of Beneficiaries Age 65 to 74 | 231 |
| Number Of Beneficiaries Age 75 to 84 | 288 |
| Number Of Beneficiaries Age Greater 84 | 245 |
| Number Of Female Beneficiaries | 451 |
| Number Of Male Beneficiaries | 448 |
| Number Of Non Hispanic White Beneficiaries | 628 |
| Number Of Black or African American Beneficiaries | 248 |
| 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 | 706 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 193 |
| Percent Of With Atrial Fibrillation | 44 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 66 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.3938 |