National Provider Identifier [NPI]: |
1134272560 |
Last Name Of The Provider |
GOULD |
First Name Of The Provider |
JUSTIN |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2100 DORCHESTER AVE |
Street Address 2 Of The Provider |
SUITE 2206 |
City Of The Provider |
DORCHESTER CENTER |
Zip Code Of The Provider |
021245615 |
State Code Of The Provider |
MA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Urology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
90 |
Number Of Services |
2913 |
Number Of Medicare Beneficiaries |
570 |
Total Submitted Charge Amount |
1050222 |
Total Medicare Allowed Amount |
282779.84 |
Total Medicare Payment Amount |
211087.84 |
Total Medicare Standardized Payment Amount |
201153.66 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
550 |
Number Of Medicare Beneficiaries With Drug Services |
32 |
Total Drug Submitted ChargeAmount |
74815 |
Total Drug Medicare AllowedAmount |
23456.45 |
Total Drug Medicare PaymentAmount |
18251.51 |
Total Drug Medicare Standardized Payment Amount |
18251.51 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
84 |
Number Of Medical Services |
2363 |
Number Of Medicare Beneficiaries With Medical Services |
570 |
Total Medical Submitted Charge Amount |
975407 |
Total Medical Medicare Allowed Amount |
259323.39 |
Total Medical Medicare Payment Amount |
192836.33 |
Total Medical Medicare Standardized Payment Amount |
182902.15 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
52 |
Number Of Beneficiaries Age 65 to 74 |
218 |
Number Of Beneficiaries Age 75 to 84 |
182 |
Number Of Beneficiaries Age Greater 84 |
118 |
Number Of Female Beneficiaries |
227 |
Number Of Male Beneficiaries |
343 |
Number Of Non Hispanic White Beneficiaries |
496 |
Number Of Black or African American Beneficiaries |
53 |
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 |
490 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
80 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
22 |
Percent Of With Heart Failure |
25 |
Percent Of With Chronic Kidney Disease |
35 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
39 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.4788 |