| National Provider Identifier [NPI]: | 1811063142 |
| Last Name Of The Provider | GOUGH |
| First Name Of The Provider | BEVERLY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1950 OLD GALLOWS RD |
| Street Address 2 Of The Provider | SUITE 520 |
| City Of The Provider | VIENNA |
| Zip Code Of The Provider | 221823990 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 429 |
| Number Of Medicare Beneficiaries | 188 |
| Total Submitted Charge Amount | 38035.81 |
| Total Medicare Allowed Amount | 31057.54 |
| Total Medicare Payment Amount | 22420.57 |
| Total Medicare Standardized Payment Amount | 23895.44 |
| 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 | 18 |
| Number Of Medical Services | 429 |
| Number Of Medicare Beneficiaries With Medical Services | 188 |
| Total Medical Submitted Charge Amount | 38035.81 |
| Total Medical Medicare Allowed Amount | 31057.54 |
| Total Medical Medicare Payment Amount | 22420.57 |
| Total Medical Medicare Standardized Payment Amount | 23895.44 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 80 |
| Number Of Beneficiaries Age 75 to 84 | 48 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 118 |
| Number Of Male Beneficiaries | 70 |
| Number Of Non Hispanic White Beneficiaries | 136 |
| 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 | 130 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 58 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2694 |