| National Provider Identifier [NPI]: | 1366498636 |
| Last Name Of The Provider | GOLDBERG |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 36001 EUCLID AVE |
| Street Address 2 Of The Provider | SUITE B-6 |
| City Of The Provider | WILLOUGHBY |
| Zip Code Of The Provider | 440944643 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 3740 |
| Number Of Medicare Beneficiaries | 193 |
| Total Submitted Charge Amount | 1008011.21 |
| Total Medicare Allowed Amount | 318441.21 |
| Total Medicare Payment Amount | 249022.11 |
| Total Medicare Standardized Payment Amount | 267077.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3020 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 3416 |
| Total Drug Medicare AllowedAmount | 776.71 |
| Total Drug Medicare PaymentAmount | 608.96 |
| Total Drug Medicare Standardized Payment Amount | 608.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 720 |
| Number Of Medicare Beneficiaries With Medical Services | 193 |
| Total Medical Submitted Charge Amount | 1004595.21 |
| Total Medical Medicare Allowed Amount | 317664.5 |
| Total Medical Medicare Payment Amount | 248413.15 |
| Total Medical Medicare Standardized Payment Amount | 266468.44 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 51 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 103 |
| Number Of Male Beneficiaries | 90 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 118 |
| 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 | 100 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 93 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 32 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 68 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 63 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 70 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 21 |
| Average HCC Risk Score Of Beneficiaries | 6.9564 |