| National Provider Identifier [NPI]: | 1265467286 |
| Last Name Of The Provider | GOODWIN |
| First Name Of The Provider | HENRY |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4350 TOWNE CENTRE DR STE 2200 |
| Street Address 2 Of The Provider | |
| City Of The Provider | EVANS |
| Zip Code Of The Provider | 308093301 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 108 |
| Number Of Services | 7668 |
| Number Of Medicare Beneficiaries | 777 |
| Total Submitted Charge Amount | 778254.35 |
| Total Medicare Allowed Amount | 232272.14 |
| Total Medicare Payment Amount | 171143.27 |
| Total Medicare Standardized Payment Amount | 181363.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 4769 |
| Number Of Medicare Beneficiaries With Drug Services | 70 |
| Total Drug Submitted ChargeAmount | 66477.5 |
| Total Drug Medicare AllowedAmount | 26027.19 |
| Total Drug Medicare PaymentAmount | 20278.34 |
| Total Drug Medicare Standardized Payment Amount | 20278.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 102 |
| Number Of Medical Services | 2899 |
| Number Of Medicare Beneficiaries With Medical Services | 777 |
| Total Medical Submitted Charge Amount | 711776.85 |
| Total Medical Medicare Allowed Amount | 206244.95 |
| Total Medical Medicare Payment Amount | 150864.93 |
| Total Medical Medicare Standardized Payment Amount | 161085.41 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 385 |
| Number Of Beneficiaries Age 75 to 84 | 255 |
| Number Of Beneficiaries Age Greater 84 | 79 |
| Number Of Female Beneficiaries | 223 |
| Number Of Male Beneficiaries | 554 |
| Number Of Non Hispanic White Beneficiaries | 623 |
| Number Of Black or African American Beneficiaries | 133 |
| 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 | 724 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 53 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1456 |