| National Provider Identifier [NPI]: | 1518009612 |
| Last Name Of The Provider | MOULTON |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1180 RESURGENCE DR |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | WATKINSVILLE |
| Zip Code Of The Provider | 306777210 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 6161 |
| Number Of Medicare Beneficiaries | 1682 |
| Total Submitted Charge Amount | 1384184.14 |
| Total Medicare Allowed Amount | 676345.89 |
| Total Medicare Payment Amount | 514913.47 |
| Total Medicare Standardized Payment Amount | 644768.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 11 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 27.5 |
| Total Drug Medicare AllowedAmount | 19.62 |
| Total Drug Medicare PaymentAmount | 15.37 |
| Total Drug Medicare Standardized Payment Amount | 15.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 6150 |
| Number Of Medicare Beneficiaries With Medical Services | 1682 |
| Total Medical Submitted Charge Amount | 1384156.64 |
| Total Medical Medicare Allowed Amount | 676326.27 |
| Total Medical Medicare Payment Amount | 514898.1 |
| Total Medical Medicare Standardized Payment Amount | 644753.53 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 89 |
| Number Of Beneficiaries Age 65 to 74 | 739 |
| Number Of Beneficiaries Age 75 to 84 | 619 |
| Number Of Beneficiaries Age Greater 84 | 235 |
| Number Of Female Beneficiaries | 677 |
| Number Of Male Beneficiaries | 1005 |
| Number Of Non Hispanic White Beneficiaries | 1631 |
| Number Of Black or African American Beneficiaries | 26 |
| 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 | 1518 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 164 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.063 |