| National Provider Identifier [NPI]: | 1821112574 |
| Last Name Of The Provider | GOLDBERG |
| First Name Of The Provider | MELVYN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1225 GRAHAM RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FLORISSANT |
| Zip Code Of The Provider | 630318014 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 1748 |
| Number Of Medicare Beneficiaries | 851 |
| Total Submitted Charge Amount | 283394 |
| Total Medicare Allowed Amount | 152943.19 |
| Total Medicare Payment Amount | 96730.43 |
| Total Medicare Standardized Payment Amount | 104119.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 83 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 2833 |
| Total Drug Medicare AllowedAmount | 601.85 |
| Total Drug Medicare PaymentAmount | 475.41 |
| Total Drug Medicare Standardized Payment Amount | 475.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 1665 |
| Number Of Medicare Beneficiaries With Medical Services | 851 |
| Total Medical Submitted Charge Amount | 280561 |
| Total Medical Medicare Allowed Amount | 152341.34 |
| Total Medical Medicare Payment Amount | 96255.02 |
| Total Medical Medicare Standardized Payment Amount | 103644.17 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 332 |
| Number Of Beneficiaries Age 65 to 74 | 298 |
| Number Of Beneficiaries Age 75 to 84 | 153 |
| Number Of Beneficiaries Age Greater 84 | 68 |
| Number Of Female Beneficiaries | 570 |
| Number Of Male Beneficiaries | 281 |
| Number Of Non Hispanic White Beneficiaries | 530 |
| Number Of Black or African American Beneficiaries | 292 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 589 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 262 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 55 |
| 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 | 5 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.0353 |