| National Provider Identifier [NPI]: | 1679516124 |
| Last Name Of The Provider | GORDON |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 512 NOKOMIS AVE S |
| Street Address 2 Of The Provider | |
| City Of The Provider | VENICE |
| Zip Code Of The Provider | 342852817 |
| 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 | 284 |
| Number Of Services | 8717 |
| Number Of Medicare Beneficiaries | 1501 |
| Total Submitted Charge Amount | 573072.51 |
| Total Medicare Allowed Amount | 452666.03 |
| Total Medicare Payment Amount | 353845.07 |
| Total Medicare Standardized Payment Amount | 354040.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 5313 |
| Number Of Medicare Beneficiaries With Drug Services | 110 |
| Total Drug Submitted ChargeAmount | 4523.5 |
| Total Drug Medicare AllowedAmount | 2203.16 |
| Total Drug Medicare PaymentAmount | 1712.93 |
| Total Drug Medicare Standardized Payment Amount | 1712.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 274 |
| Number Of Medical Services | 3404 |
| Number Of Medicare Beneficiaries With Medical Services | 1501 |
| Total Medical Submitted Charge Amount | 568549.01 |
| Total Medical Medicare Allowed Amount | 450462.87 |
| Total Medical Medicare Payment Amount | 352132.14 |
| Total Medical Medicare Standardized Payment Amount | 352327.5 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 88 |
| Number Of Beneficiaries Age 65 to 74 | 411 |
| Number Of Beneficiaries Age 75 to 84 | 557 |
| Number Of Beneficiaries Age Greater 84 | 445 |
| Number Of Female Beneficiaries | 779 |
| Number Of Male Beneficiaries | 722 |
| Number Of Non Hispanic White Beneficiaries | 1450 |
| Number Of Black or African American Beneficiaries | 16 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1341 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 160 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 24 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.9306 |