| National Provider Identifier [NPI]: | 1801058821 |
| Last Name Of The Provider | MOORE |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 139 FAIRFIELD DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | HATTIESBURG |
| Zip Code Of The Provider | 394021303 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 8927 |
| Number Of Medicare Beneficiaries | 544 |
| Total Submitted Charge Amount | 822066 |
| Total Medicare Allowed Amount | 225773.77 |
| Total Medicare Payment Amount | 168132.49 |
| Total Medicare Standardized Payment Amount | 183412.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 5723 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 110395 |
| Total Drug Medicare AllowedAmount | 32478.59 |
| Total Drug Medicare PaymentAmount | 25282.28 |
| Total Drug Medicare Standardized Payment Amount | 25282.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 112 |
| Number Of Medical Services | 3204 |
| Number Of Medicare Beneficiaries With Medical Services | 544 |
| Total Medical Submitted Charge Amount | 711671 |
| Total Medical Medicare Allowed Amount | 193295.18 |
| Total Medical Medicare Payment Amount | 142850.21 |
| Total Medical Medicare Standardized Payment Amount | 158129.99 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 120 |
| Number Of Beneficiaries Age 65 to 74 | 252 |
| Number Of Beneficiaries Age 75 to 84 | 125 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 168 |
| Number Of Male Beneficiaries | 376 |
| Number Of Non Hispanic White Beneficiaries | 404 |
| 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 | 374 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 170 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.215 |