| National Provider Identifier [NPI]: | 1235228685 |
| Last Name Of The Provider | GOLDSBERRY |
| First Name Of The Provider | GRANT |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1215 DUFF AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | AMES |
| Zip Code Of The Provider | 500103014 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 221 |
| Number Of Services | 26141 |
| Number Of Medicare Beneficiaries | 4813 |
| Total Submitted Charge Amount | 1887647.64 |
| Total Medicare Allowed Amount | 546509.71 |
| Total Medicare Payment Amount | 432067.72 |
| Total Medicare Standardized Payment Amount | 470054.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 17190 |
| Number Of Medicare Beneficiaries With Drug Services | 283 |
| Total Drug Submitted ChargeAmount | 21969.9 |
| Total Drug Medicare AllowedAmount | 5478.8 |
| Total Drug Medicare PaymentAmount | 4295.55 |
| Total Drug Medicare Standardized Payment Amount | 4295.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 219 |
| Number Of Medical Services | 8951 |
| Number Of Medicare Beneficiaries With Medical Services | 4813 |
| Total Medical Submitted Charge Amount | 1865677.74 |
| Total Medical Medicare Allowed Amount | 541030.91 |
| Total Medical Medicare Payment Amount | 427772.17 |
| Total Medical Medicare Standardized Payment Amount | 465758.72 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 535 |
| Number Of Beneficiaries Age 65 to 74 | 1866 |
| Number Of Beneficiaries Age 75 to 84 | 1550 |
| Number Of Beneficiaries Age Greater 84 | 862 |
| Number Of Female Beneficiaries | 3215 |
| Number Of Male Beneficiaries | 1598 |
| Number Of Non Hispanic White Beneficiaries | 4646 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | 25 |
| Number Of Beneficiaries With Race Not Else where Classified | 54 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4074 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 739 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2819 |