| National Provider Identifier [NPI]: | 1134329691 |
| Last Name Of The Provider | GOODELL |
| First Name Of The Provider | KRISTEN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 92 HIGH ST |
| Street Address 2 Of The Provider | MEDFORD FAMILY CARE |
| City Of The Provider | MEDFORD |
| Zip Code Of The Provider | 021553850 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 361 |
| Number Of Medicare Beneficiaries | 104 |
| Total Submitted Charge Amount | 57320 |
| Total Medicare Allowed Amount | 28234.28 |
| Total Medicare Payment Amount | 21398.97 |
| Total Medicare Standardized Payment Amount | 20154.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 2490 |
| Total Drug Medicare AllowedAmount | 1725.19 |
| Total Drug Medicare PaymentAmount | 1669.88 |
| Total Drug Medicare Standardized Payment Amount | 1669.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 319 |
| Number Of Medicare Beneficiaries With Medical Services | 104 |
| Total Medical Submitted Charge Amount | 54830 |
| Total Medical Medicare Allowed Amount | 26509.09 |
| Total Medical Medicare Payment Amount | 19729.09 |
| Total Medical Medicare Standardized Payment Amount | 18485.02 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 36 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 68 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 90 |
| Number Of Black or African American Beneficiaries | |
| 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 | 67 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| 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 | 13 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8921 |