| National Provider Identifier [NPI]: | 1346220035 |
| Last Name Of The Provider | GOUGH-FIBKINS |
| First Name Of The Provider | SHAWN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9824 SW 133RD CT |
| Street Address 2 Of The Provider | |
| City Of The Provider | MIAMI |
| Zip Code Of The Provider | 331862203 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 197 |
| Number Of Services | 5402 |
| Number Of Medicare Beneficiaries | 3503 |
| Total Submitted Charge Amount | 763023 |
| Total Medicare Allowed Amount | 166724.74 |
| Total Medicare Payment Amount | 124975.57 |
| Total Medicare Standardized Payment Amount | 121091.29 |
| 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 | 197 |
| Number Of Medical Services | 5402 |
| Number Of Medicare Beneficiaries With Medical Services | 3503 |
| Total Medical Submitted Charge Amount | 763023 |
| Total Medical Medicare Allowed Amount | 166724.74 |
| Total Medical Medicare Payment Amount | 124975.57 |
| Total Medical Medicare Standardized Payment Amount | 121091.29 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 829 |
| Number Of Beneficiaries Age 65 to 74 | 1133 |
| Number Of Beneficiaries Age 75 to 84 | 833 |
| Number Of Beneficiaries Age Greater 84 | 708 |
| Number Of Female Beneficiaries | 1899 |
| Number Of Male Beneficiaries | 1604 |
| Number Of Non Hispanic White Beneficiaries | 2311 |
| Number Of Black or African American Beneficiaries | 772 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 300 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 60 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2142 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1361 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.1007 |