| National Provider Identifier [NPI]: | 1871691154 |
| Last Name Of The Provider | GOLDES |
| First Name Of The Provider | JEFFRY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 50 SOUTH LAST CHANCE GULCH |
| Street Address 2 Of The Provider | STE 3 |
| City Of The Provider | HELENA |
| Zip Code Of The Provider | 596014134 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 10552 |
| Number Of Medicare Beneficiaries | 1890 |
| Total Submitted Charge Amount | 1165940.1 |
| Total Medicare Allowed Amount | 541166.12 |
| Total Medicare Payment Amount | 395394.6 |
| Total Medicare Standardized Payment Amount | 320224.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 202 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 949.25 |
| Total Drug Medicare AllowedAmount | 361.23 |
| Total Drug Medicare PaymentAmount | 248.92 |
| Total Drug Medicare Standardized Payment Amount | 248.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 10350 |
| Number Of Medicare Beneficiaries With Medical Services | 1890 |
| Total Medical Submitted Charge Amount | 1164990.85 |
| Total Medical Medicare Allowed Amount | 540804.89 |
| Total Medical Medicare Payment Amount | 395145.68 |
| Total Medical Medicare Standardized Payment Amount | 319976.05 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 113 |
| Number Of Beneficiaries Age 65 to 74 | 956 |
| Number Of Beneficiaries Age 75 to 84 | 590 |
| Number Of Beneficiaries Age Greater 84 | 231 |
| Number Of Female Beneficiaries | 842 |
| Number Of Male Beneficiaries | 1048 |
| Number Of Non Hispanic White Beneficiaries | 1820 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1797 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 93 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 29 |
| Percent Of With Hypertension | 40 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.849 |