| National Provider Identifier [NPI]: | 1891704177 |
| Last Name Of The Provider | GOODMAN |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8933 ACTIVITY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921264427 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 122 |
| Number Of Services | 29255 |
| Number Of Medicare Beneficiaries | 1298 |
| Total Submitted Charge Amount | 1138367 |
| Total Medicare Allowed Amount | 341998.69 |
| Total Medicare Payment Amount | 261326.45 |
| Total Medicare Standardized Payment Amount | 252743.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 27346 |
| Number Of Medicare Beneficiaries With Drug Services | 304 |
| Total Drug Submitted ChargeAmount | 82824 |
| Total Drug Medicare AllowedAmount | 7008.3 |
| Total Drug Medicare PaymentAmount | 5494.38 |
| Total Drug Medicare Standardized Payment Amount | 5494.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 117 |
| Number Of Medical Services | 1909 |
| Number Of Medicare Beneficiaries With Medical Services | 1298 |
| Total Medical Submitted Charge Amount | 1055543 |
| Total Medical Medicare Allowed Amount | 334990.39 |
| Total Medical Medicare Payment Amount | 255832.07 |
| Total Medical Medicare Standardized Payment Amount | 247248.69 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 631 |
| Number Of Beneficiaries Age 75 to 84 | 401 |
| Number Of Beneficiaries Age Greater 84 | 167 |
| Number Of Female Beneficiaries | 771 |
| Number Of Male Beneficiaries | 527 |
| Number Of Non Hispanic White Beneficiaries | 894 |
| Number Of Black or African American Beneficiaries | 50 |
| Number Of AsianPacific Islander Beneficiaries | 130 |
| Number Of Hispanic Beneficiaries | 178 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1071 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 227 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1522 |