| National Provider Identifier [NPI]: | 1669422713 |
| Last Name Of The Provider | GOULD |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3237 S 16TH ST |
| Street Address 2 Of The Provider | RADIOLOGY DEPT. 2ND FLOOR |
| City Of The Provider | MILWAUKEE |
| Zip Code Of The Provider | 532154526 |
| 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 | 183 |
| Number Of Services | 3850 |
| Number Of Medicare Beneficiaries | 2280 |
| Total Submitted Charge Amount | 703012.91 |
| Total Medicare Allowed Amount | 127220.65 |
| Total Medicare Payment Amount | 95960.11 |
| Total Medicare Standardized Payment Amount | 100708.91 |
| 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 | 183 |
| Number Of Medical Services | 3850 |
| Number Of Medicare Beneficiaries With Medical Services | 2280 |
| Total Medical Submitted Charge Amount | 703012.91 |
| Total Medical Medicare Allowed Amount | 127220.65 |
| Total Medical Medicare Payment Amount | 95960.11 |
| Total Medical Medicare Standardized Payment Amount | 100708.91 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 437 |
| Number Of Beneficiaries Age 65 to 74 | 720 |
| Number Of Beneficiaries Age 75 to 84 | 674 |
| Number Of Beneficiaries Age Greater 84 | 449 |
| Number Of Female Beneficiaries | 1449 |
| Number Of Male Beneficiaries | 831 |
| Number Of Non Hispanic White Beneficiaries | 1916 |
| Number Of Black or African American Beneficiaries | 108 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 202 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1623 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 657 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6711 |