| National Provider Identifier [NPI]: | 1619915295 |
| Last Name Of The Provider | D'SOUZA |
| First Name Of The Provider | GODWIN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5600 W ADDISON ST |
| Street Address 2 Of The Provider | SUITE LL001 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606344401 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 13769 |
| Number Of Medicare Beneficiaries | 1079 |
| Total Submitted Charge Amount | 1557667 |
| Total Medicare Allowed Amount | 1030098.93 |
| Total Medicare Payment Amount | 782477.59 |
| Total Medicare Standardized Payment Amount | 733775.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 404 |
| Number Of Medicare Beneficiaries With Drug Services | 210 |
| Total Drug Submitted ChargeAmount | 16660 |
| Total Drug Medicare AllowedAmount | 2731.53 |
| Total Drug Medicare PaymentAmount | 2566.13 |
| Total Drug Medicare Standardized Payment Amount | 2566.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 13365 |
| Number Of Medicare Beneficiaries With Medical Services | 1079 |
| Total Medical Submitted Charge Amount | 1541007 |
| Total Medical Medicare Allowed Amount | 1027367.4 |
| Total Medical Medicare Payment Amount | 779911.46 |
| Total Medical Medicare Standardized Payment Amount | 731209.84 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 176 |
| Number Of Beneficiaries Age 65 to 74 | 292 |
| Number Of Beneficiaries Age 75 to 84 | 303 |
| Number Of Beneficiaries Age Greater 84 | 308 |
| Number Of Female Beneficiaries | 682 |
| Number Of Male Beneficiaries | 397 |
| Number Of Non Hispanic White Beneficiaries | 714 |
| Number Of Black or African American Beneficiaries | 79 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 241 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 565 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 514 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 35 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 59 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 70 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.1754 |