| National Provider Identifier [NPI]: | 1750319851 |
| Last Name Of The Provider | GOODMAN |
| First Name Of The Provider | LEE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7253 AMBASSADOR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212442710 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 154 |
| Number Of Services | 9272 |
| Number Of Medicare Beneficiaries | 3632 |
| Total Submitted Charge Amount | 699088.49 |
| Total Medicare Allowed Amount | 217004.15 |
| Total Medicare Payment Amount | 164833.2 |
| Total Medicare Standardized Payment Amount | 158886.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 3160 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 726.8 |
| Total Drug Medicare AllowedAmount | 622.6 |
| Total Drug Medicare PaymentAmount | 466.13 |
| Total Drug Medicare Standardized Payment Amount | 466.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 153 |
| Number Of Medical Services | 6112 |
| Number Of Medicare Beneficiaries With Medical Services | 3632 |
| Total Medical Submitted Charge Amount | 698361.69 |
| Total Medical Medicare Allowed Amount | 216381.55 |
| Total Medical Medicare Payment Amount | 164367.07 |
| Total Medical Medicare Standardized Payment Amount | 158420.16 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 415 |
| Number Of Beneficiaries Age 65 to 74 | 1196 |
| Number Of Beneficiaries Age 75 to 84 | 1101 |
| Number Of Beneficiaries Age Greater 84 | 920 |
| Number Of Female Beneficiaries | 2210 |
| Number Of Male Beneficiaries | 1422 |
| Number Of Non Hispanic White Beneficiaries | 2920 |
| Number Of Black or African American Beneficiaries | 596 |
| Number Of AsianPacific Islander Beneficiaries | 40 |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3180 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 452 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7799 |