| National Provider Identifier [NPI]: | 1508804626 |
| Last Name Of The Provider | GOYSICH |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | PSY.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4579 S EASON BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUPELO |
| Zip Code Of The Provider | 388016539 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Clinical Psychologist |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 918 |
| Number Of Medicare Beneficiaries | 269 |
| Total Submitted Charge Amount | 83940 |
| Total Medicare Allowed Amount | 21266.02 |
| Total Medicare Payment Amount | 16584.54 |
| Total Medicare Standardized Payment Amount | 7319.69 |
| 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 | 4 |
| Number Of Medical Services | 918 |
| Number Of Medicare Beneficiaries With Medical Services | 269 |
| Total Medical Submitted Charge Amount | 83940 |
| Total Medical Medicare Allowed Amount | 21266.02 |
| Total Medical Medicare Payment Amount | 16584.54 |
| Total Medical Medicare Standardized Payment Amount | 7319.69 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 87 |
| Number Of Beneficiaries Age 75 to 84 | 85 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 130 |
| Number Of Male Beneficiaries | 139 |
| Number Of Non Hispanic White Beneficiaries | 203 |
| Number Of Black or African American Beneficiaries | |
| 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 | 167 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 102 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 58 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 24 |
| Percent Of With Stroke | 52 |
| Average HCC Risk Score Of Beneficiaries | 1.7974 |