| National Provider Identifier [NPI]: | 1265451603 |
| Last Name Of The Provider | GOLDBERG |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2650 RIDGE AVE |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY, G507 |
| City Of The Provider | EVANSTON |
| Zip Code Of The Provider | 602011718 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 3038 |
| Number Of Medicare Beneficiaries | 2276 |
| Total Submitted Charge Amount | 684386 |
| Total Medicare Allowed Amount | 208505.68 |
| Total Medicare Payment Amount | 158887.15 |
| Total Medicare Standardized Payment Amount | 151325.76 |
| 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 | 55 |
| Number Of Medical Services | 3038 |
| Number Of Medicare Beneficiaries With Medical Services | 2276 |
| Total Medical Submitted Charge Amount | 684386 |
| Total Medical Medicare Allowed Amount | 208505.68 |
| Total Medical Medicare Payment Amount | 158887.15 |
| Total Medical Medicare Standardized Payment Amount | 151325.76 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 159 |
| Number Of Beneficiaries Age 65 to 74 | 649 |
| Number Of Beneficiaries Age 75 to 84 | 790 |
| Number Of Beneficiaries Age Greater 84 | 678 |
| Number Of Female Beneficiaries | 1357 |
| Number Of Male Beneficiaries | 919 |
| Number Of Non Hispanic White Beneficiaries | 1998 |
| Number Of Black or African American Beneficiaries | 103 |
| Number Of AsianPacific Islander Beneficiaries | 93 |
| Number Of Hispanic Beneficiaries | 56 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1921 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 355 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 21 |
| Average HCC Risk Score Of Beneficiaries | 1.5637 |