| National Provider Identifier [NPI]: | 1912919036 |
| Last Name Of The Provider | GO |
| First Name Of The Provider | KIMBERLY |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | ANP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 PORT WASHINGTON BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROSLYN |
| Zip Code Of The Provider | 115761353 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 1073 |
| Number Of Medicare Beneficiaries | 340 |
| Total Submitted Charge Amount | 246060.4 |
| Total Medicare Allowed Amount | 74305.28 |
| Total Medicare Payment Amount | 57807.48 |
| Total Medicare Standardized Payment Amount | 61007.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 4 |
| Number Of Medical Services | 1073 |
| Number Of Medicare Beneficiaries With Medical Services | 340 |
| Total Medical Submitted Charge Amount | 246060.4 |
| Total Medical Medicare Allowed Amount | 74305.28 |
| Total Medical Medicare Payment Amount | 57807.48 |
| Total Medical Medicare Standardized Payment Amount | 61007.11 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 93 |
| Number Of Beneficiaries Age 75 to 84 | 125 |
| Number Of Beneficiaries Age Greater 84 | 107 |
| Number Of Female Beneficiaries | 149 |
| Number Of Male Beneficiaries | 191 |
| Number Of Non Hispanic White Beneficiaries | 321 |
| 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 | 306 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 54 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 70 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 64 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.9637 |