| National Provider Identifier [NPI]: | 1164405734 |
| Last Name Of The Provider | MOATE |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1750 N HAMPTON RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DESOTO |
| Zip Code Of The Provider | 751152306 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 163 |
| Number Of Services | 10920 |
| Number Of Medicare Beneficiaries | 1949 |
| Total Submitted Charge Amount | 852221.21 |
| Total Medicare Allowed Amount | 164108.58 |
| Total Medicare Payment Amount | 123952.99 |
| Total Medicare Standardized Payment Amount | 128196.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 7771 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 9833.2 |
| Total Drug Medicare AllowedAmount | 1909.36 |
| Total Drug Medicare PaymentAmount | 1417.17 |
| Total Drug Medicare Standardized Payment Amount | 1417.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 157 |
| Number Of Medical Services | 3149 |
| Number Of Medicare Beneficiaries With Medical Services | 1949 |
| Total Medical Submitted Charge Amount | 842388.01 |
| Total Medical Medicare Allowed Amount | 162199.22 |
| Total Medical Medicare Payment Amount | 122535.82 |
| Total Medical Medicare Standardized Payment Amount | 126779.45 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 574 |
| Number Of Beneficiaries Age 65 to 74 | 678 |
| Number Of Beneficiaries Age 75 to 84 | 444 |
| Number Of Beneficiaries Age Greater 84 | 253 |
| Number Of Female Beneficiaries | 1157 |
| Number Of Male Beneficiaries | 792 |
| Number Of Non Hispanic White Beneficiaries | 727 |
| Number Of Black or African American Beneficiaries | 892 |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| Number Of Hispanic Beneficiaries | 273 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1092 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 857 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.6715 |