| National Provider Identifier [NPI]: | 1487712295 |
| Last Name Of The Provider | MOON |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1359 N MOUNT AUBURN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CAPE GIRARDEAU |
| Zip Code Of The Provider | 637011727 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 138 |
| Number Of Services | 26703 |
| Number Of Medicare Beneficiaries | 2744 |
| Total Submitted Charge Amount | 3566537.52 |
| Total Medicare Allowed Amount | 1680031.83 |
| Total Medicare Payment Amount | 1254571.6 |
| Total Medicare Standardized Payment Amount | 1267679.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 450 |
| Number Of Medicare Beneficiaries With Drug Services | 177 |
| Total Drug Submitted ChargeAmount | 84580 |
| Total Drug Medicare AllowedAmount | 75192.15 |
| Total Drug Medicare PaymentAmount | 58140.6 |
| Total Drug Medicare Standardized Payment Amount | 58140.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 134 |
| Number Of Medical Services | 26253 |
| Number Of Medicare Beneficiaries With Medical Services | 2744 |
| Total Medical Submitted Charge Amount | 3481957.52 |
| Total Medical Medicare Allowed Amount | 1604839.68 |
| Total Medical Medicare Payment Amount | 1196431 |
| Total Medical Medicare Standardized Payment Amount | 1209538.96 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 239 |
| Number Of Beneficiaries Age 65 to 74 | 1299 |
| Number Of Beneficiaries Age 75 to 84 | 848 |
| Number Of Beneficiaries Age Greater 84 | 358 |
| Number Of Female Beneficiaries | 1409 |
| Number Of Male Beneficiaries | 1335 |
| Number Of Non Hispanic White Beneficiaries | 2694 |
| Number Of Black or African American Beneficiaries | 27 |
| 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 | 2413 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 331 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0347 |