| National Provider Identifier [NPI]: | 1679525141 |
| Last Name Of The Provider | GORDON |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 235 N PEARL ST |
| Street Address 2 Of The Provider | RADIOLOGY DEPARTMENT |
| City Of The Provider | BROCKTON |
| Zip Code Of The Provider | 023011794 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 120 |
| Number Of Services | 2689 |
| Number Of Medicare Beneficiaries | 1853 |
| Total Submitted Charge Amount | 203019 |
| Total Medicare Allowed Amount | 66210.66 |
| Total Medicare Payment Amount | 50274.94 |
| Total Medicare Standardized Payment Amount | 49969.05 |
| 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 | 120 |
| Number Of Medical Services | 2689 |
| Number Of Medicare Beneficiaries With Medical Services | 1853 |
| Total Medical Submitted Charge Amount | 203019 |
| Total Medical Medicare Allowed Amount | 66210.66 |
| Total Medical Medicare Payment Amount | 50274.94 |
| Total Medical Medicare Standardized Payment Amount | 49969.05 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 334 |
| Number Of Beneficiaries Age 65 to 74 | 585 |
| Number Of Beneficiaries Age 75 to 84 | 516 |
| Number Of Beneficiaries Age Greater 84 | 418 |
| Number Of Female Beneficiaries | 1098 |
| Number Of Male Beneficiaries | 755 |
| Number Of Non Hispanic White Beneficiaries | 1702 |
| Number Of Black or African American Beneficiaries | 29 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 77 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1311 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 542 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5162 |