| National Provider Identifier [NPI]: | 1730375601 |
| Last Name Of The Provider | GOUGH |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7190 SW 87TH AVE |
| Street Address 2 Of The Provider | STE. 304 |
| City Of The Provider | MIAMI |
| Zip Code Of The Provider | 331732507 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 111 |
| Number Of Services | 10115 |
| Number Of Medicare Beneficiaries | 541 |
| Total Submitted Charge Amount | 923061.72 |
| Total Medicare Allowed Amount | 350217.9 |
| Total Medicare Payment Amount | 270559.4 |
| Total Medicare Standardized Payment Amount | 280781.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 4508 |
| Number Of Medicare Beneficiaries With Drug Services | 359 |
| Total Drug Submitted ChargeAmount | 193602 |
| Total Drug Medicare AllowedAmount | 99837.29 |
| Total Drug Medicare PaymentAmount | 78132.43 |
| Total Drug Medicare Standardized Payment Amount | 78132.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 5607 |
| Number Of Medicare Beneficiaries With Medical Services | 541 |
| Total Medical Submitted Charge Amount | 729459.72 |
| Total Medical Medicare Allowed Amount | 250380.61 |
| Total Medical Medicare Payment Amount | 192426.97 |
| Total Medical Medicare Standardized Payment Amount | 202648.93 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 242 |
| Number Of Beneficiaries Age 75 to 84 | 169 |
| Number Of Beneficiaries Age Greater 84 | 85 |
| Number Of Female Beneficiaries | 403 |
| Number Of Male Beneficiaries | 138 |
| Number Of Non Hispanic White Beneficiaries | 378 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 137 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 455 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 86 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 32 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3502 |