| National Provider Identifier [NPI]: | 1013990431 |
| Last Name Of The Provider | GOYCO |
| First Name Of The Provider | OTTO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 900 SANDERS RD |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | CUMMING |
| Zip Code Of The Provider | 300415960 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 5111 |
| Number Of Medicare Beneficiaries | 901 |
| Total Submitted Charge Amount | 1032222 |
| Total Medicare Allowed Amount | 376971.24 |
| Total Medicare Payment Amount | 283703.24 |
| Total Medicare Standardized Payment Amount | 286223.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 518 |
| Number Of Medicare Beneficiaries With Drug Services | 361 |
| Total Drug Submitted ChargeAmount | 41336 |
| Total Drug Medicare AllowedAmount | 30345.97 |
| Total Drug Medicare PaymentAmount | 29707.41 |
| Total Drug Medicare Standardized Payment Amount | 29707.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 4593 |
| Number Of Medicare Beneficiaries With Medical Services | 901 |
| Total Medical Submitted Charge Amount | 990886 |
| Total Medical Medicare Allowed Amount | 346625.27 |
| Total Medical Medicare Payment Amount | 253995.83 |
| Total Medical Medicare Standardized Payment Amount | 256516.2 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 366 |
| Number Of Beneficiaries Age 75 to 84 | 336 |
| Number Of Beneficiaries Age Greater 84 | 135 |
| Number Of Female Beneficiaries | 497 |
| Number Of Male Beneficiaries | 404 |
| Number Of Non Hispanic White Beneficiaries | 852 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 824 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 77 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2433 |