| National Provider Identifier [NPI]: | 1396762910 |
| Last Name Of The Provider | MOORE |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2630 HIGHWAY K |
| Street Address 2 Of The Provider | |
| City Of The Provider | O FALLON |
| Zip Code Of The Provider | 633686624 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 524 |
| Number Of Medicare Beneficiaries | 249 |
| Total Submitted Charge Amount | 38578.5 |
| Total Medicare Allowed Amount | 25571.01 |
| Total Medicare Payment Amount | 16769.77 |
| Total Medicare Standardized Payment Amount | 17531.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 131 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 1774.5 |
| Total Drug Medicare AllowedAmount | 412.12 |
| Total Drug Medicare PaymentAmount | 374.27 |
| Total Drug Medicare Standardized Payment Amount | 374.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 393 |
| Number Of Medicare Beneficiaries With Medical Services | 249 |
| Total Medical Submitted Charge Amount | 36804 |
| Total Medical Medicare Allowed Amount | 25158.89 |
| Total Medical Medicare Payment Amount | 16395.5 |
| Total Medical Medicare Standardized Payment Amount | 17156.76 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 123 |
| Number Of Beneficiaries Age 75 to 84 | 63 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 152 |
| Number Of Male Beneficiaries | 97 |
| Number Of Non Hispanic White Beneficiaries | 231 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 222 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9067 |