| National Provider Identifier [NPI]: | 1831159714 |
| Last Name Of The Provider | GOODMAN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8631 W 3RD ST |
| Street Address 2 Of The Provider | SUITE #445E |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900485901 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 100 |
| Number Of Services | 8931 |
| Number Of Medicare Beneficiaries | 1279 |
| Total Submitted Charge Amount | 2817147.71 |
| Total Medicare Allowed Amount | 909177.52 |
| Total Medicare Payment Amount | 692742.07 |
| Total Medicare Standardized Payment Amount | 643060.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 2100 |
| Total Drug Medicare AllowedAmount | 505.68 |
| Total Drug Medicare PaymentAmount | 495.6 |
| Total Drug Medicare Standardized Payment Amount | 495.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 8889 |
| Number Of Medicare Beneficiaries With Medical Services | 1279 |
| Total Medical Submitted Charge Amount | 2815047.71 |
| Total Medical Medicare Allowed Amount | 908671.84 |
| Total Medical Medicare Payment Amount | 692246.47 |
| Total Medical Medicare Standardized Payment Amount | 642564.55 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 340 |
| Number Of Beneficiaries Age 75 to 84 | 446 |
| Number Of Beneficiaries Age Greater 84 | 448 |
| Number Of Female Beneficiaries | 621 |
| Number Of Male Beneficiaries | 658 |
| Number Of Non Hispanic White Beneficiaries | 932 |
| Number Of Black or African American Beneficiaries | 178 |
| Number Of AsianPacific Islander Beneficiaries | 71 |
| Number Of Hispanic Beneficiaries | 59 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 884 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 395 |
| Percent Of With Atrial Fibrillation | 39 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 57 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.0781 |