| National Provider Identifier [NPI]: | 1518037605 |
| Last Name Of The Provider | GODWIN |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7220 LOUIS PASTEUR |
| Street Address 2 Of The Provider | STE #115 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 78229 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 155 |
| Number Of Services | 10971 |
| Number Of Medicare Beneficiaries | 1313 |
| Total Submitted Charge Amount | 1848732 |
| Total Medicare Allowed Amount | 276013.93 |
| Total Medicare Payment Amount | 208071.87 |
| Total Medicare Standardized Payment Amount | 230040.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 9082 |
| Number Of Medicare Beneficiaries With Drug Services | 196 |
| Total Drug Submitted ChargeAmount | 19621 |
| Total Drug Medicare AllowedAmount | 3509.35 |
| Total Drug Medicare PaymentAmount | 2709.12 |
| Total Drug Medicare Standardized Payment Amount | 2709.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 152 |
| Number Of Medical Services | 1889 |
| Number Of Medicare Beneficiaries With Medical Services | 1312 |
| Total Medical Submitted Charge Amount | 1829111 |
| Total Medical Medicare Allowed Amount | 272504.58 |
| Total Medical Medicare Payment Amount | 205362.75 |
| Total Medical Medicare Standardized Payment Amount | 227331.08 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 294 |
| Number Of Beneficiaries Age 65 to 74 | 612 |
| Number Of Beneficiaries Age 75 to 84 | 307 |
| Number Of Beneficiaries Age Greater 84 | 100 |
| Number Of Female Beneficiaries | 793 |
| Number Of Male Beneficiaries | 520 |
| Number Of Non Hispanic White Beneficiaries | 696 |
| Number Of Black or African American Beneficiaries | 44 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 544 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1012 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 301 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2272 |