| National Provider Identifier [NPI]: | 1558397489 |
| Last Name Of The Provider | MOULTON |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 813 FOUNDERS PARK DR E |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGDALE |
| Zip Code Of The Provider | 727626314 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 3354 |
| Number Of Medicare Beneficiaries | 967 |
| Total Submitted Charge Amount | 697018.4 |
| Total Medicare Allowed Amount | 363775.66 |
| Total Medicare Payment Amount | 277415.13 |
| Total Medicare Standardized Payment Amount | 297321.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 16 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 320 |
| Total Drug Medicare AllowedAmount | 282.39 |
| Total Drug Medicare PaymentAmount | 275.42 |
| Total Drug Medicare Standardized Payment Amount | 275.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 3338 |
| Number Of Medicare Beneficiaries With Medical Services | 967 |
| Total Medical Submitted Charge Amount | 696698.4 |
| Total Medical Medicare Allowed Amount | 363493.27 |
| Total Medical Medicare Payment Amount | 277139.71 |
| Total Medical Medicare Standardized Payment Amount | 297046.15 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 230 |
| Number Of Beneficiaries Age 65 to 74 | 309 |
| Number Of Beneficiaries Age 75 to 84 | 303 |
| Number Of Beneficiaries Age Greater 84 | 125 |
| Number Of Female Beneficiaries | 471 |
| Number Of Male Beneficiaries | 496 |
| Number Of Non Hispanic White Beneficiaries | 867 |
| Number Of Black or African American Beneficiaries | 21 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 742 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 225 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 3.3119 |