| National Provider Identifier [NPI]: | 1427163906 |
| Last Name Of The Provider | GOUDA |
| First Name Of The Provider | JAN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 ELIZABETH PL |
| Street Address 2 Of The Provider | SUITE # D |
| City Of The Provider | DAYTON |
| Zip Code Of The Provider | 454173445 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 7476 |
| Number Of Medicare Beneficiaries | 405 |
| Total Submitted Charge Amount | 524024 |
| Total Medicare Allowed Amount | 230678.9 |
| Total Medicare Payment Amount | 175935.1 |
| Total Medicare Standardized Payment Amount | 191672.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 18 |
| Number Of Drug Services | 5388 |
| Number Of Medicare Beneficiaries With Drug Services | 175 |
| Total Drug Submitted ChargeAmount | 102980 |
| Total Drug Medicare AllowedAmount | 43341.83 |
| Total Drug Medicare PaymentAmount | 33450.95 |
| Total Drug Medicare Standardized Payment Amount | 33450.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 2088 |
| Number Of Medicare Beneficiaries With Medical Services | 404 |
| Total Medical Submitted Charge Amount | 421044 |
| Total Medical Medicare Allowed Amount | 187337.07 |
| Total Medical Medicare Payment Amount | 142484.15 |
| Total Medical Medicare Standardized Payment Amount | 158221.83 |
| Average Age Of Beneficiaries | 57 |
| Number Of Beneficiaries Age Less65 | 294 |
| Number Of Beneficiaries Age 65 to 74 | 76 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 255 |
| Number Of Male Beneficiaries | 150 |
| Number Of Non Hispanic White Beneficiaries | 327 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 156 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 249 |
| Percent Of With Atrial Fibrillation | 3 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 51 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 72 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.5509 |