| National Provider Identifier [NPI]: | 1881801322 |
| Last Name Of The Provider | MOSES |
| First Name Of The Provider | NICOLE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 905 N 1ST ST |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | ELBURN |
| Zip Code Of The Provider | 601199150 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 978 |
| Number Of Medicare Beneficiaries | 283 |
| Total Submitted Charge Amount | 113143 |
| Total Medicare Allowed Amount | 71002.31 |
| Total Medicare Payment Amount | 48403.97 |
| Total Medicare Standardized Payment Amount | 45887.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 103 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 3897 |
| Total Drug Medicare AllowedAmount | 1203.58 |
| Total Drug Medicare PaymentAmount | 1144.88 |
| Total Drug Medicare Standardized Payment Amount | 1144.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 875 |
| Number Of Medicare Beneficiaries With Medical Services | 283 |
| Total Medical Submitted Charge Amount | 109246 |
| Total Medical Medicare Allowed Amount | 69798.73 |
| Total Medical Medicare Payment Amount | 47259.09 |
| Total Medical Medicare Standardized Payment Amount | 44742.41 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | 127 |
| Number Of Beneficiaries Age 75 to 84 | 92 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 181 |
| Number Of Male Beneficiaries | 102 |
| Number Of Non Hispanic White Beneficiaries | 272 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9861 |