| National Provider Identifier [NPI]: | 1679652689 |
| Last Name Of The Provider | GOTH |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1969 W HART RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BELOIT |
| Zip Code Of The Provider | 535112230 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 194 |
| Number Of Services | 5560 |
| Number Of Medicare Beneficiaries | 2677 |
| Total Submitted Charge Amount | 1263384 |
| Total Medicare Allowed Amount | 175104.41 |
| Total Medicare Payment Amount | 128895.57 |
| Total Medicare Standardized Payment Amount | 134685.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 194 |
| Number Of Medical Services | 5560 |
| Number Of Medicare Beneficiaries With Medical Services | 2677 |
| Total Medical Submitted Charge Amount | 1263384 |
| Total Medical Medicare Allowed Amount | 175104.41 |
| Total Medical Medicare Payment Amount | 128895.57 |
| Total Medical Medicare Standardized Payment Amount | 134685.87 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 560 |
| Number Of Beneficiaries Age 65 to 74 | 935 |
| Number Of Beneficiaries Age 75 to 84 | 772 |
| Number Of Beneficiaries Age Greater 84 | 410 |
| Number Of Female Beneficiaries | 1669 |
| Number Of Male Beneficiaries | 1008 |
| Number Of Non Hispanic White Beneficiaries | 2334 |
| Number Of Black or African American Beneficiaries | 243 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 70 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1888 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 789 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3961 |