| National Provider Identifier [NPI]: | 1003858762 |
| Last Name Of The Provider | GOODALE |
| First Name Of The Provider | MIRANDA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1214 E NATIONAL AVE |
| Street Address 2 Of The Provider | SUITE 130 |
| City Of The Provider | BRAZIL |
| Zip Code Of The Provider | 478342700 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 3396 |
| Number Of Medicare Beneficiaries | 897 |
| Total Submitted Charge Amount | 246783 |
| Total Medicare Allowed Amount | 126480.87 |
| Total Medicare Payment Amount | 88491.32 |
| Total Medicare Standardized Payment Amount | 95111.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 418 |
| Total Drug Medicare AllowedAmount | 72.76 |
| Total Drug Medicare PaymentAmount | 53.68 |
| Total Drug Medicare Standardized Payment Amount | 53.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 3320 |
| Number Of Medicare Beneficiaries With Medical Services | 897 |
| Total Medical Submitted Charge Amount | 246365 |
| Total Medical Medicare Allowed Amount | 126408.11 |
| Total Medical Medicare Payment Amount | 88437.64 |
| Total Medical Medicare Standardized Payment Amount | 95057.57 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 246 |
| Number Of Beneficiaries Age 75 to 84 | 293 |
| Number Of Beneficiaries Age Greater 84 | 281 |
| Number Of Female Beneficiaries | 559 |
| Number Of Male Beneficiaries | 338 |
| Number Of Non Hispanic White Beneficiaries | 881 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 700 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 197 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6365 |