| National Provider Identifier [NPI]: | 1215996640 |
| Last Name Of The Provider | GOLDMAN |
| First Name Of The Provider | ALLAN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4350 E CAMELBACK RD |
| Street Address 2 Of The Provider | STE. F-100 |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850182701 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 2209 |
| Number Of Medicare Beneficiaries | 217 |
| Total Submitted Charge Amount | 173250.3 |
| Total Medicare Allowed Amount | 86988.78 |
| Total Medicare Payment Amount | 66882.61 |
| Total Medicare Standardized Payment Amount | 69795.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 85 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 2479.5 |
| Total Drug Medicare AllowedAmount | 1670.48 |
| Total Drug Medicare PaymentAmount | 1624.95 |
| Total Drug Medicare Standardized Payment Amount | 1624.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 2124 |
| Number Of Medicare Beneficiaries With Medical Services | 217 |
| Total Medical Submitted Charge Amount | 170770.8 |
| Total Medical Medicare Allowed Amount | 85318.3 |
| Total Medical Medicare Payment Amount | 65257.66 |
| Total Medical Medicare Standardized Payment Amount | 68170.33 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | 112 |
| Number Of Beneficiaries Age 75 to 84 | 60 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 101 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 201 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 26 |
| 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 | 0.894 |