| National Provider Identifier [NPI]: | 1801822473 |
| Last Name Of The Provider | GO |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 220 KENNEDY DR |
| Street Address 2 Of The Provider | 540 LITCHFIELD ST |
| City Of The Provider | TORRINGTON |
| Zip Code Of The Provider | 01790 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 190 |
| Number Of Services | 9156 |
| Number Of Medicare Beneficiaries | 2573 |
| Total Submitted Charge Amount | 886934.15 |
| Total Medicare Allowed Amount | 277691.07 |
| Total Medicare Payment Amount | 216629.44 |
| Total Medicare Standardized Payment Amount | 200639.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 4199 |
| Number Of Medicare Beneficiaries With Drug Services | 90 |
| Total Drug Submitted ChargeAmount | 6754.65 |
| Total Drug Medicare AllowedAmount | 2065.88 |
| Total Drug Medicare PaymentAmount | 1619.63 |
| Total Drug Medicare Standardized Payment Amount | 1619.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 186 |
| Number Of Medical Services | 4957 |
| Number Of Medicare Beneficiaries With Medical Services | 2573 |
| Total Medical Submitted Charge Amount | 880179.5 |
| Total Medical Medicare Allowed Amount | 275625.19 |
| Total Medical Medicare Payment Amount | 215009.81 |
| Total Medical Medicare Standardized Payment Amount | 199019.43 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 395 |
| Number Of Beneficiaries Age 65 to 74 | 902 |
| Number Of Beneficiaries Age 75 to 84 | 792 |
| Number Of Beneficiaries Age Greater 84 | 484 |
| Number Of Female Beneficiaries | 1849 |
| Number Of Male Beneficiaries | 724 |
| Number Of Non Hispanic White Beneficiaries | 2446 |
| Number Of Black or African American Beneficiaries | 28 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 48 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1634 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 939 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3911 |