| National Provider Identifier [NPI]: | 1184667750 |
| Last Name Of The Provider | GOODMAN |
| First Name Of The Provider | SHIRLEY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 43 CROSSWAYS PARK DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WOODBURY |
| Zip Code Of The Provider | 117972002 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 787 |
| Number Of Medicare Beneficiaries | 213 |
| Total Submitted Charge Amount | 278512 |
| Total Medicare Allowed Amount | 70709.73 |
| Total Medicare Payment Amount | 53633.53 |
| Total Medicare Standardized Payment Amount | 46907.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 66 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 4653 |
| Total Drug Medicare AllowedAmount | 1593.58 |
| Total Drug Medicare PaymentAmount | 1552.87 |
| Total Drug Medicare Standardized Payment Amount | 1552.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 721 |
| Number Of Medicare Beneficiaries With Medical Services | 213 |
| Total Medical Submitted Charge Amount | 273859 |
| Total Medical Medicare Allowed Amount | 69116.15 |
| Total Medical Medicare Payment Amount | 52080.66 |
| Total Medical Medicare Standardized Payment Amount | 45354.35 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 95 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 192 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 191 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2481 |