| National Provider Identifier [NPI]: | 1700983137 |
| Last Name Of The Provider | GOULD |
| First Name Of The Provider | LEE |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 307 ST. JOHN'S WAY |
| Street Address 2 Of The Provider | SUITE 114 |
| City Of The Provider | LEWISTON |
| Zip Code Of The Provider | 835012456 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 5745 |
| Number Of Medicare Beneficiaries | 2427 |
| Total Submitted Charge Amount | 243737.5 |
| Total Medicare Allowed Amount | 191632.6 |
| Total Medicare Payment Amount | 135548.78 |
| Total Medicare Standardized Payment Amount | 142222.06 |
| 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 | 24 |
| Number Of Medical Services | 5745 |
| Number Of Medicare Beneficiaries With Medical Services | 2427 |
| Total Medical Submitted Charge Amount | 243737.5 |
| Total Medical Medicare Allowed Amount | 191632.6 |
| Total Medical Medicare Payment Amount | 135548.78 |
| Total Medical Medicare Standardized Payment Amount | 142222.06 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 317 |
| Number Of Beneficiaries Age 65 to 74 | 794 |
| Number Of Beneficiaries Age 75 to 84 | 812 |
| Number Of Beneficiaries Age Greater 84 | 504 |
| Number Of Female Beneficiaries | 1269 |
| Number Of Male Beneficiaries | 1158 |
| Number Of Non Hispanic White Beneficiaries | 2302 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | 75 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1895 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 532 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4602 |