| National Provider Identifier [NPI]: | 1336499730 |
| Last Name Of The Provider | GODINA |
| First Name Of The Provider | RAUL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4815 CLEVELAND BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CALDWELL |
| Zip Code Of The Provider | 836056501 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 1229 |
| Number Of Medicare Beneficiaries | 340 |
| Total Submitted Charge Amount | 225291.57 |
| Total Medicare Allowed Amount | 73494.17 |
| Total Medicare Payment Amount | 52588.61 |
| Total Medicare Standardized Payment Amount | 63744.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 142 |
| Number Of Medicare Beneficiaries With Drug Services | 91 |
| Total Drug Submitted ChargeAmount | 7844 |
| Total Drug Medicare AllowedAmount | 2534.17 |
| Total Drug Medicare PaymentAmount | 2360.06 |
| Total Drug Medicare Standardized Payment Amount | 2360.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 1087 |
| Number Of Medicare Beneficiaries With Medical Services | 340 |
| Total Medical Submitted Charge Amount | 217447.57 |
| Total Medical Medicare Allowed Amount | 70960 |
| Total Medical Medicare Payment Amount | 50228.55 |
| Total Medical Medicare Standardized Payment Amount | 61384.54 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 157 |
| Number Of Beneficiaries Age 75 to 84 | 108 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 188 |
| Number Of Male Beneficiaries | 152 |
| Number Of Non Hispanic White Beneficiaries | 231 |
| 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 | 271 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1253 |