| National Provider Identifier [NPI]: | 1013291715 |
| Last Name Of The Provider | MOY |
| First Name Of The Provider | SHARON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1300 FRANKLIN AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | NORMAL |
| Zip Code Of The Provider | 617613592 |
| 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 | 37 |
| Number Of Services | 383 |
| Number Of Medicare Beneficiaries | 131 |
| Total Submitted Charge Amount | 47381 |
| Total Medicare Allowed Amount | 25770.31 |
| Total Medicare Payment Amount | 19396.54 |
| Total Medicare Standardized Payment Amount | 20268.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 815 |
| Total Drug Medicare AllowedAmount | 418.64 |
| Total Drug Medicare PaymentAmount | 409.68 |
| Total Drug Medicare Standardized Payment Amount | 409.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 361 |
| Number Of Medicare Beneficiaries With Medical Services | 130 |
| Total Medical Submitted Charge Amount | 46566 |
| Total Medical Medicare Allowed Amount | 25351.67 |
| Total Medical Medicare Payment Amount | 18986.86 |
| Total Medical Medicare Standardized Payment Amount | 19859.15 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 81 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | 118 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 104 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3006 |