| National Provider Identifier [NPI]: | 1205897295 |
| Last Name Of The Provider | GOLDWAG |
| First Name Of The Provider | STUART |
| 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 | 150 KINGSLEY LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORFOLK |
| Zip Code Of The Provider | 235054602 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 194 |
| Number Of Services | 4606 |
| Number Of Medicare Beneficiaries | 3266 |
| Total Submitted Charge Amount | 800106 |
| Total Medicare Allowed Amount | 210183.02 |
| Total Medicare Payment Amount | 161615.91 |
| Total Medicare Standardized Payment Amount | 166595.95 |
| 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 | 194 |
| Number Of Medical Services | 4606 |
| Number Of Medicare Beneficiaries With Medical Services | 3266 |
| Total Medical Submitted Charge Amount | 800106 |
| Total Medical Medicare Allowed Amount | 210183.02 |
| Total Medical Medicare Payment Amount | 161615.91 |
| Total Medical Medicare Standardized Payment Amount | 166595.95 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 504 |
| Number Of Beneficiaries Age 65 to 74 | 1171 |
| Number Of Beneficiaries Age 75 to 84 | 1005 |
| Number Of Beneficiaries Age Greater 84 | 586 |
| Number Of Female Beneficiaries | 1945 |
| Number Of Male Beneficiaries | 1321 |
| Number Of Non Hispanic White Beneficiaries | 2419 |
| Number Of Black or African American Beneficiaries | 674 |
| Number Of AsianPacific Islander Beneficiaries | 46 |
| Number Of Hispanic Beneficiaries | 86 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2703 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 563 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 1.7631 |