| National Provider Identifier [NPI]: | 1285610766 |
| Last Name Of The Provider | MOOTE |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 85 SEYMOUR ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | HARTFORD |
| Zip Code Of The Provider | 061065501 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 5120 |
| Number Of Medicare Beneficiaries | 2678 |
| Total Submitted Charge Amount | 363284 |
| Total Medicare Allowed Amount | 97519.11 |
| Total Medicare Payment Amount | 73238.97 |
| Total Medicare Standardized Payment Amount | 70050.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1350 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 4050 |
| Total Drug Medicare AllowedAmount | 251.15 |
| Total Drug Medicare PaymentAmount | 196.88 |
| Total Drug Medicare Standardized Payment Amount | 196.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 149 |
| Number Of Medical Services | 3770 |
| Number Of Medicare Beneficiaries With Medical Services | 2678 |
| Total Medical Submitted Charge Amount | 359234 |
| Total Medical Medicare Allowed Amount | 97267.96 |
| Total Medical Medicare Payment Amount | 73042.09 |
| Total Medical Medicare Standardized Payment Amount | 69853.65 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 527 |
| Number Of Beneficiaries Age 65 to 74 | 754 |
| Number Of Beneficiaries Age 75 to 84 | 771 |
| Number Of Beneficiaries Age Greater 84 | 626 |
| Number Of Female Beneficiaries | 1464 |
| Number Of Male Beneficiaries | 1214 |
| Number Of Non Hispanic White Beneficiaries | 2152 |
| Number Of Black or African American Beneficiaries | 175 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 270 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1586 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1092 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.1472 |