| National Provider Identifier [NPI]: | 1962592907 |
| Last Name Of The Provider | ELDICK |
| First Name Of The Provider | MOUSTAFA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 899 N SUMMIT ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CRESCENT CITY |
| Zip Code Of The Provider | 321122109 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 17322 |
| Number Of Medicare Beneficiaries | 978 |
| Total Submitted Charge Amount | 1094268.68 |
| Total Medicare Allowed Amount | 874510.84 |
| Total Medicare Payment Amount | 651037.9 |
| Total Medicare Standardized Payment Amount | 607520.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 5492 |
| Number Of Medicare Beneficiaries With Drug Services | 250 |
| Total Drug Submitted ChargeAmount | 57964 |
| Total Drug Medicare AllowedAmount | 18629.55 |
| Total Drug Medicare PaymentAmount | 14733.37 |
| Total Drug Medicare Standardized Payment Amount | 14733.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 11830 |
| Number Of Medicare Beneficiaries With Medical Services | 978 |
| Total Medical Submitted Charge Amount | 1036304.68 |
| Total Medical Medicare Allowed Amount | 855881.29 |
| Total Medical Medicare Payment Amount | 636304.53 |
| Total Medical Medicare Standardized Payment Amount | 592787.08 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 231 |
| Number Of Beneficiaries Age 65 to 74 | 328 |
| Number Of Beneficiaries Age 75 to 84 | 268 |
| Number Of Beneficiaries Age Greater 84 | 151 |
| Number Of Female Beneficiaries | 534 |
| Number Of Male Beneficiaries | 444 |
| Number Of Non Hispanic White Beneficiaries | 849 |
| Number Of Black or African American Beneficiaries | 92 |
| 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 | 532 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 446 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7998 |