| National Provider Identifier [NPI]: | 1902808793 |
| Last Name Of The Provider | MOODY |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 W IRONWOOD DR |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | COEUR D ALENE |
| Zip Code Of The Provider | 838142656 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 250 |
| Number Of Services | 3900 |
| Number Of Medicare Beneficiaries | 2390 |
| Total Submitted Charge Amount | 528758 |
| Total Medicare Allowed Amount | 141640.08 |
| Total Medicare Payment Amount | 105973.7 |
| Total Medicare Standardized Payment Amount | 113611.73 |
| 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 | 250 |
| Number Of Medical Services | 3900 |
| Number Of Medicare Beneficiaries With Medical Services | 2390 |
| Total Medical Submitted Charge Amount | 528758 |
| Total Medical Medicare Allowed Amount | 141640.08 |
| Total Medical Medicare Payment Amount | 105973.7 |
| Total Medical Medicare Standardized Payment Amount | 113611.73 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 406 |
| Number Of Beneficiaries Age 65 to 74 | 984 |
| Number Of Beneficiaries Age 75 to 84 | 685 |
| Number Of Beneficiaries Age Greater 84 | 315 |
| Number Of Female Beneficiaries | 1478 |
| Number Of Male Beneficiaries | 912 |
| Number Of Non Hispanic White Beneficiaries | 2285 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | 31 |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1801 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 589 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4735 |