| National Provider Identifier [NPI]: | 1235232646 |
| Last Name Of The Provider | GOBLE |
| First Name Of The Provider | EDWIN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 274 N MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOGAN |
| Zip Code Of The Provider | 843213915 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 329 |
| Number Of Medicare Beneficiaries | 65 |
| Total Submitted Charge Amount | 142152.34 |
| Total Medicare Allowed Amount | 37527.29 |
| Total Medicare Payment Amount | 29104.08 |
| Total Medicare Standardized Payment Amount | 29442.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 169 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 4715 |
| Total Drug Medicare AllowedAmount | 2065.43 |
| Total Drug Medicare PaymentAmount | 1573.33 |
| Total Drug Medicare Standardized Payment Amount | 1573.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 160 |
| Number Of Medicare Beneficiaries With Medical Services | 65 |
| Total Medical Submitted Charge Amount | 137437.34 |
| Total Medical Medicare Allowed Amount | 35461.86 |
| Total Medical Medicare Payment Amount | 27530.75 |
| Total Medical Medicare Standardized Payment Amount | 27869.6 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 35 |
| Number Of Beneficiaries Age 75 to 84 | 18 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 37 |
| Number Of Male Beneficiaries | 28 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.8205 |