| National Provider Identifier [NPI]: | 1356332449 |
| Last Name Of The Provider | MOULTON |
| First Name Of The Provider | STACY |
| 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 | 1001 SAM PERRY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FREDERICKSBURG |
| Zip Code Of The Provider | 224014453 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 138 |
| Number Of Services | 23154 |
| Number Of Medicare Beneficiaries | 2448 |
| Total Submitted Charge Amount | 1983314.9 |
| Total Medicare Allowed Amount | 300591.01 |
| Total Medicare Payment Amount | 225243.23 |
| Total Medicare Standardized Payment Amount | 238284.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 19754 |
| Number Of Medicare Beneficiaries With Drug Services | 279 |
| Total Drug Submitted ChargeAmount | 63537.5 |
| Total Drug Medicare AllowedAmount | 6512.55 |
| Total Drug Medicare PaymentAmount | 4826.75 |
| Total Drug Medicare Standardized Payment Amount | 4826.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 135 |
| Number Of Medical Services | 3400 |
| Number Of Medicare Beneficiaries With Medical Services | 2447 |
| Total Medical Submitted Charge Amount | 1919777.4 |
| Total Medical Medicare Allowed Amount | 294078.46 |
| Total Medical Medicare Payment Amount | 220416.48 |
| Total Medical Medicare Standardized Payment Amount | 233457.4 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 373 |
| Number Of Beneficiaries Age 65 to 74 | 987 |
| Number Of Beneficiaries Age 75 to 84 | 749 |
| Number Of Beneficiaries Age Greater 84 | 339 |
| Number Of Female Beneficiaries | 1441 |
| Number Of Male Beneficiaries | 1007 |
| Number Of Non Hispanic White Beneficiaries | 1975 |
| Number Of Black or African American Beneficiaries | 377 |
| Number Of AsianPacific Islander Beneficiaries | 30 |
| Number Of Hispanic Beneficiaries | 46 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2034 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 414 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7612 |