| National Provider Identifier [NPI]: | 1508891235 |
| Last Name Of The Provider | GOODRICH |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 205 N BELLE MEAD AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAST SETAUKET |
| Zip Code Of The Provider | 11733 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 2352 |
| Number Of Medicare Beneficiaries | 546 |
| Total Submitted Charge Amount | 330108 |
| Total Medicare Allowed Amount | 188407.68 |
| Total Medicare Payment Amount | 140577.35 |
| Total Medicare Standardized Payment Amount | 125076.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 440 |
| Number Of Medicare Beneficiaries With Drug Services | 273 |
| Total Drug Submitted ChargeAmount | 26742 |
| Total Drug Medicare AllowedAmount | 21827.52 |
| Total Drug Medicare PaymentAmount | 21190.33 |
| Total Drug Medicare Standardized Payment Amount | 21190.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 1912 |
| Number Of Medicare Beneficiaries With Medical Services | 546 |
| Total Medical Submitted Charge Amount | 303366 |
| Total Medical Medicare Allowed Amount | 166580.16 |
| Total Medical Medicare Payment Amount | 119387.02 |
| Total Medical Medicare Standardized Payment Amount | 103886.58 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 205 |
| Number Of Beneficiaries Age 75 to 84 | 204 |
| Number Of Beneficiaries Age Greater 84 | 88 |
| Number Of Female Beneficiaries | 278 |
| Number Of Male Beneficiaries | 268 |
| Number Of Non Hispanic White Beneficiaries | 489 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 492 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2141 |