| National Provider Identifier [NPI]: | 1417258963 |
| Last Name Of The Provider | GOODMAN |
| First Name Of The Provider | STACEY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MSN, RN, ANP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1135 W UNIVERSITY DR |
| Street Address 2 Of The Provider | SUITE 425 |
| City Of The Provider | ROCHESTER |
| Zip Code Of The Provider | 483071871 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 8 |
| Number Of Services | 168 |
| Number Of Medicare Beneficiaries | 94 |
| Total Submitted Charge Amount | 21885 |
| Total Medicare Allowed Amount | 12634.16 |
| Total Medicare Payment Amount | 9830.02 |
| Total Medicare Standardized Payment Amount | 11139.53 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
| Number Of Medical Services | |
| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
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| Average Age Of Beneficiaries | 82 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 68 |
| Number Of Male Beneficiaries | 26 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 77 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 46 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 67 |
| Percent Of With Chronic Kidney Disease | 63 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 71 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 32 |
| Average HCC Risk Score Of Beneficiaries | 2.304 |