| National Provider Identifier [NPI]: | 1912974148 |
| Last Name Of The Provider | MOORHEAD |
| First Name Of The Provider | IAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 550 OSBORNE RD NE |
| Street Address 2 Of The Provider | UNITY HOSPITAL |
| City Of The Provider | FRIDLEY |
| Zip Code Of The Provider | 55432 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 1046 |
| Number Of Medicare Beneficiaries | 203 |
| Total Submitted Charge Amount | 134514.36 |
| Total Medicare Allowed Amount | 30679.38 |
| Total Medicare Payment Amount | 22668.1 |
| Total Medicare Standardized Payment Amount | 23540.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 636 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 1044.36 |
| Total Drug Medicare AllowedAmount | 197.42 |
| Total Drug Medicare PaymentAmount | 142.14 |
| Total Drug Medicare Standardized Payment Amount | 142.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 410 |
| Number Of Medicare Beneficiaries With Medical Services | 203 |
| Total Medical Submitted Charge Amount | 133470 |
| Total Medical Medicare Allowed Amount | 30481.96 |
| Total Medical Medicare Payment Amount | 22525.96 |
| Total Medical Medicare Standardized Payment Amount | 23398.78 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 82 |
| Number Of Beneficiaries Age 65 to 74 | 42 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 118 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | 177 |
| Number Of Black or African American Beneficiaries | 14 |
| 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 | 128 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4822 |