| National Provider Identifier [NPI]: | 1669474060 |
| Last Name Of The Provider | GODSHALL |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1751 ERICKSON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HARRISONBURG |
| Zip Code Of The Provider | 228018555 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 117 |
| Number Of Services | 6524 |
| Number Of Medicare Beneficiaries | 725 |
| Total Submitted Charge Amount | 302788 |
| Total Medicare Allowed Amount | 225039.92 |
| Total Medicare Payment Amount | 166876.76 |
| Total Medicare Standardized Payment Amount | 170390.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 433 |
| Number Of Medicare Beneficiaries With Drug Services | 195 |
| Total Drug Submitted ChargeAmount | 7315.42 |
| Total Drug Medicare AllowedAmount | 6000.57 |
| Total Drug Medicare PaymentAmount | 5452.92 |
| Total Drug Medicare Standardized Payment Amount | 5452.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 106 |
| Number Of Medical Services | 6091 |
| Number Of Medicare Beneficiaries With Medical Services | 725 |
| Total Medical Submitted Charge Amount | 295472.58 |
| Total Medical Medicare Allowed Amount | 219039.35 |
| Total Medical Medicare Payment Amount | 161423.84 |
| Total Medical Medicare Standardized Payment Amount | 164937.79 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 248 |
| Number Of Beneficiaries Age 75 to 84 | 232 |
| Number Of Beneficiaries Age Greater 84 | 216 |
| Number Of Female Beneficiaries | 440 |
| Number Of Male Beneficiaries | 285 |
| Number Of Non Hispanic White Beneficiaries | 712 |
| 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 | 653 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 72 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0722 |