National Provider Identifier [NPI]: |
1336134980 |
Last Name Of The Provider |
MOORE |
First Name Of The Provider |
TORY |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
OD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
600 E 1ST ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
DUMAS |
Zip Code Of The Provider |
790293216 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Optometry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
22 |
Number Of Services |
552 |
Number Of Medicare Beneficiaries |
282 |
Total Submitted Charge Amount |
78057 |
Total Medicare Allowed Amount |
46647.27 |
Total Medicare Payment Amount |
30969.1 |
Total Medicare Standardized Payment Amount |
32368.44 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
22 |
Number Of Medical Services |
552 |
Number Of Medicare Beneficiaries With Medical Services |
282 |
Total Medical Submitted Charge Amount |
78057 |
Total Medical Medicare Allowed Amount |
46647.27 |
Total Medical Medicare Payment Amount |
30969.1 |
Total Medical Medicare Standardized Payment Amount |
32368.44 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
20 |
Number Of Beneficiaries Age 65 to 74 |
135 |
Number Of Beneficiaries Age 75 to 84 |
86 |
Number Of Beneficiaries Age Greater 84 |
41 |
Number Of Female Beneficiaries |
167 |
Number Of Male Beneficiaries |
115 |
Number Of Non Hispanic White Beneficiaries |
209 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
212 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
70 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
21 |
Percent Of With Diabetes |
34 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.1173 |