| National Provider Identifier [NPI]: | 1679542781 |
| Last Name Of The Provider | MOSS |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 814 NORTHWOOD PARK DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | VALDOSTA |
| Zip Code Of The Provider | 316021398 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 16165 |
| Number Of Medicare Beneficiaries | 598 |
| Total Submitted Charge Amount | 3478492.2 |
| Total Medicare Allowed Amount | 1472633.34 |
| Total Medicare Payment Amount | 1129508.33 |
| Total Medicare Standardized Payment Amount | 1177214.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 394 |
| Number Of Medicare Beneficiaries With Drug Services | 91 |
| Total Drug Submitted ChargeAmount | 30010 |
| Total Drug Medicare AllowedAmount | 1054.71 |
| Total Drug Medicare PaymentAmount | 763.4 |
| Total Drug Medicare Standardized Payment Amount | 763.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 15771 |
| Number Of Medicare Beneficiaries With Medical Services | 598 |
| Total Medical Submitted Charge Amount | 3448482.2 |
| Total Medical Medicare Allowed Amount | 1471578.63 |
| Total Medical Medicare Payment Amount | 1128744.93 |
| Total Medical Medicare Standardized Payment Amount | 1176450.76 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 161 |
| Number Of Beneficiaries Age 75 to 84 | 165 |
| Number Of Beneficiaries Age Greater 84 | 101 |
| Number Of Female Beneficiaries | 349 |
| Number Of Male Beneficiaries | 249 |
| Number Of Non Hispanic White Beneficiaries | 417 |
| Number Of Black or African American Beneficiaries | 155 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 255 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 343 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 36 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0166 |