| National Provider Identifier [NPI]: | 1255453429 |
| Last Name Of The Provider | MORENO |
| First Name Of The Provider | JUAN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 122 N ALAMO RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ALAMO |
| Zip Code Of The Provider | 785162200 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 636 |
| Number Of Medicare Beneficiaries | 96 |
| Total Submitted Charge Amount | 32990 |
| Total Medicare Allowed Amount | 18158.99 |
| Total Medicare Payment Amount | 13750.63 |
| Total Medicare Standardized Payment Amount | 15306.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 80 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 4670 |
| Total Drug Medicare AllowedAmount | 124.07 |
| Total Drug Medicare PaymentAmount | 107.36 |
| Total Drug Medicare Standardized Payment Amount | 107.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 556 |
| Number Of Medicare Beneficiaries With Medical Services | 96 |
| Total Medical Submitted Charge Amount | 28320 |
| Total Medical Medicare Allowed Amount | 18034.92 |
| Total Medical Medicare Payment Amount | 13643.27 |
| Total Medical Medicare Standardized Payment Amount | 15199.41 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 40 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 51 |
| Number Of Male Beneficiaries | 45 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 52 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 47 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9906 |