| National Provider Identifier [NPI]: | 1639396914 |
| Last Name Of The Provider | GOODMAN |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4701 SANGAMORE ROAD |
| Street Address 2 Of The Provider | SUITE 5207 |
| City Of The Provider | BETHESDA |
| Zip Code Of The Provider | 208162529 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 903 |
| Number Of Medicare Beneficiaries | 176 |
| Total Submitted Charge Amount | 81409.15 |
| Total Medicare Allowed Amount | 72383.8 |
| Total Medicare Payment Amount | 52703.89 |
| Total Medicare Standardized Payment Amount | 55443.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 59 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 2908.48 |
| Total Drug Medicare AllowedAmount | 1806.16 |
| Total Drug Medicare PaymentAmount | 1770.08 |
| Total Drug Medicare Standardized Payment Amount | 1770.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 844 |
| Number Of Medicare Beneficiaries With Medical Services | 176 |
| Total Medical Submitted Charge Amount | 78500.67 |
| Total Medical Medicare Allowed Amount | 70577.64 |
| Total Medical Medicare Payment Amount | 50933.81 |
| Total Medical Medicare Standardized Payment Amount | 53673.53 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 98 |
| Number Of Beneficiaries Age 75 to 84 | 48 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 113 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 149 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 6 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 10 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 39 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7964 |