| National Provider Identifier [NPI]: | 1104018951 |
| Last Name Of The Provider | MOLDESTAD |
| First Name Of The Provider | ERIC |
| 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 | 2020 PALOMINO LANE |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891064894 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 297 |
| Number Of Services | 17478 |
| Number Of Medicare Beneficiaries | 2582 |
| Total Submitted Charge Amount | 1192214.53 |
| Total Medicare Allowed Amount | 291787.13 |
| Total Medicare Payment Amount | 221290.13 |
| Total Medicare Standardized Payment Amount | 216355 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 13595 |
| Number Of Medicare Beneficiaries With Drug Services | 140 |
| Total Drug Submitted ChargeAmount | 39852.62 |
| Total Drug Medicare AllowedAmount | 2787.05 |
| Total Drug Medicare PaymentAmount | 2184.85 |
| Total Drug Medicare Standardized Payment Amount | 2184.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 292 |
| Number Of Medical Services | 3883 |
| Number Of Medicare Beneficiaries With Medical Services | 2582 |
| Total Medical Submitted Charge Amount | 1152361.91 |
| Total Medical Medicare Allowed Amount | 289000.08 |
| Total Medical Medicare Payment Amount | 219105.28 |
| Total Medical Medicare Standardized Payment Amount | 214170.15 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 549 |
| Number Of Beneficiaries Age 65 to 74 | 1008 |
| Number Of Beneficiaries Age 75 to 84 | 702 |
| Number Of Beneficiaries Age Greater 84 | 323 |
| Number Of Female Beneficiaries | 1337 |
| Number Of Male Beneficiaries | 1245 |
| Number Of Non Hispanic White Beneficiaries | 1772 |
| Number Of Black or African American Beneficiaries | 344 |
| Number Of AsianPacific Islander Beneficiaries | 130 |
| Number Of Hispanic Beneficiaries | 270 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 52 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1858 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 724 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.2126 |