| National Provider Identifier [NPI]: | 1093759193 |
| Last Name Of The Provider | MORON |
| First Name Of The Provider | FANNY |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4600 E SAM HOUSTON PKWY S |
| Street Address 2 Of The Provider | |
| City Of The Provider | PASADENA |
| Zip Code Of The Provider | 775053948 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 5787 |
| Number Of Medicare Beneficiaries | 1204 |
| Total Submitted Charge Amount | 880036.75 |
| Total Medicare Allowed Amount | 207104.72 |
| Total Medicare Payment Amount | 153383.49 |
| Total Medicare Standardized Payment Amount | 158266.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 4226 |
| Number Of Medicare Beneficiaries With Drug Services | 163 |
| Total Drug Submitted ChargeAmount | 6957.75 |
| Total Drug Medicare AllowedAmount | 3091.9 |
| Total Drug Medicare PaymentAmount | 2400.99 |
| Total Drug Medicare Standardized Payment Amount | 2400.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 1561 |
| Number Of Medicare Beneficiaries With Medical Services | 1204 |
| Total Medical Submitted Charge Amount | 873079 |
| Total Medical Medicare Allowed Amount | 204012.82 |
| Total Medical Medicare Payment Amount | 150982.5 |
| Total Medical Medicare Standardized Payment Amount | 155865.97 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 338 |
| Number Of Beneficiaries Age 65 to 74 | 450 |
| Number Of Beneficiaries Age 75 to 84 | 266 |
| Number Of Beneficiaries Age Greater 84 | 150 |
| Number Of Female Beneficiaries | 675 |
| Number Of Male Beneficiaries | 529 |
| Number Of Non Hispanic White Beneficiaries | 643 |
| Number Of Black or African American Beneficiaries | 340 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 191 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 828 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 376 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 1.6414 |