| National Provider Identifier [NPI]: | 1174506620 |
| Last Name Of The Provider | GOLDSTEIN |
| First Name Of The Provider | KEN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400D HOSPITAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WARRENTON |
| Zip Code Of The Provider | 201863026 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 2268 |
| Number Of Medicare Beneficiaries | 525 |
| Total Submitted Charge Amount | 247369.97 |
| Total Medicare Allowed Amount | 143892 |
| Total Medicare Payment Amount | 106807.93 |
| Total Medicare Standardized Payment Amount | 99840.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 196 |
| Number Of Medicare Beneficiaries With Drug Services | 53 |
| Total Drug Submitted ChargeAmount | 4270 |
| Total Drug Medicare AllowedAmount | 2143.07 |
| Total Drug Medicare PaymentAmount | 1666.34 |
| Total Drug Medicare Standardized Payment Amount | 1666.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 2072 |
| Number Of Medicare Beneficiaries With Medical Services | 525 |
| Total Medical Submitted Charge Amount | 243099.97 |
| Total Medical Medicare Allowed Amount | 141748.93 |
| Total Medical Medicare Payment Amount | 105141.59 |
| Total Medical Medicare Standardized Payment Amount | 98174.6 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 207 |
| Number Of Beneficiaries Age 75 to 84 | 183 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 302 |
| Number Of Male Beneficiaries | 223 |
| Number Of Non Hispanic White Beneficiaries | 446 |
| Number Of Black or African American Beneficiaries | 53 |
| 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 | 473 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3386 |