| National Provider Identifier [NPI]: | 1134117385 |
| Last Name Of The Provider | DODGEN |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 315 E ASH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PERRY |
| Zip Code Of The Provider | 323472029 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 209 |
| Number Of Services | 8255 |
| Number Of Medicare Beneficiaries | 569 |
| Total Submitted Charge Amount | 630404 |
| Total Medicare Allowed Amount | 297547.62 |
| Total Medicare Payment Amount | 220277.9 |
| Total Medicare Standardized Payment Amount | 224339.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 19 |
| Number Of Drug Services | 2474 |
| Number Of Medicare Beneficiaries With Drug Services | 153 |
| Total Drug Submitted ChargeAmount | 23928 |
| Total Drug Medicare AllowedAmount | 3136.94 |
| Total Drug Medicare PaymentAmount | 2406.89 |
| Total Drug Medicare Standardized Payment Amount | 2406.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 190 |
| Number Of Medical Services | 5781 |
| Number Of Medicare Beneficiaries With Medical Services | 569 |
| Total Medical Submitted Charge Amount | 606476 |
| Total Medical Medicare Allowed Amount | 294410.68 |
| Total Medical Medicare Payment Amount | 217871.01 |
| Total Medical Medicare Standardized Payment Amount | 221932.39 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 108 |
| Number Of Beneficiaries Age 65 to 74 | 221 |
| Number Of Beneficiaries Age 75 to 84 | 169 |
| Number Of Beneficiaries Age Greater 84 | 71 |
| Number Of Female Beneficiaries | 346 |
| Number Of Male Beneficiaries | 223 |
| Number Of Non Hispanic White Beneficiaries | 475 |
| 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 | 418 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 151 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.2043 |