| National Provider Identifier [NPI]: | 1073711602 |
| Last Name Of The Provider | GORDON |
| First Name Of The Provider | AMANDA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4030 WEST HENDERSON ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 43220 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 181 |
| Number Of Services | 6839 |
| Number Of Medicare Beneficiaries | 200 |
| Total Submitted Charge Amount | 288244 |
| Total Medicare Allowed Amount | 142796.76 |
| Total Medicare Payment Amount | 116312.03 |
| Total Medicare Standardized Payment Amount | 120657.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 2118 |
| Number Of Medicare Beneficiaries With Drug Services | 101 |
| Total Drug Submitted ChargeAmount | 9437 |
| Total Drug Medicare AllowedAmount | 5993.18 |
| Total Drug Medicare PaymentAmount | 5594.11 |
| Total Drug Medicare Standardized Payment Amount | 5594.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 172 |
| Number Of Medical Services | 4721 |
| Number Of Medicare Beneficiaries With Medical Services | 200 |
| Total Medical Submitted Charge Amount | 278807 |
| Total Medical Medicare Allowed Amount | 136803.58 |
| Total Medical Medicare Payment Amount | 110717.92 |
| Total Medical Medicare Standardized Payment Amount | 115063.21 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 98 |
| Number Of Beneficiaries Age 75 to 84 | 61 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 142 |
| Number Of Male Beneficiaries | 58 |
| Number Of Non Hispanic White Beneficiaries | 188 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 189 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0164 |