| National Provider Identifier [NPI]: | 1649470469 |
| Last Name Of The Provider | GOSS |
| First Name Of The Provider | JORDAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 808 BROOK AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WICHITA FALLS |
| Zip Code Of The Provider | 763014209 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 225 |
| Number Of Services | 9119 |
| Number Of Medicare Beneficiaries | 5076 |
| Total Submitted Charge Amount | 1222553 |
| Total Medicare Allowed Amount | 268998.67 |
| Total Medicare Payment Amount | 210629.67 |
| Total Medicare Standardized Payment Amount | 219657.18 |
| 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 | 225 |
| Number Of Medical Services | 9119 |
| Number Of Medicare Beneficiaries With Medical Services | 5076 |
| Total Medical Submitted Charge Amount | 1222553 |
| Total Medical Medicare Allowed Amount | 268998.67 |
| Total Medical Medicare Payment Amount | 210629.67 |
| Total Medical Medicare Standardized Payment Amount | 219657.18 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1095 |
| Number Of Beneficiaries Age 65 to 74 | 1728 |
| Number Of Beneficiaries Age 75 to 84 | 1576 |
| Number Of Beneficiaries Age Greater 84 | 677 |
| Number Of Female Beneficiaries | 3056 |
| Number Of Male Beneficiaries | 2020 |
| Number Of Non Hispanic White Beneficiaries | 4331 |
| Number Of Black or African American Beneficiaries | 324 |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 334 |
| Number Of American Indian Alaska Native Beneficiaries | 35 |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3807 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1269 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.6615 |