| National Provider Identifier [NPI]: | 1073776407 |
| Last Name Of The Provider | HODGE |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 70 DOCTOR'S PARK |
| Street Address 2 Of The Provider | |
| City Of The Provider | CAPE GIRARDEAU |
| Zip Code Of The Provider | 63703 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 10984 |
| Number Of Medicare Beneficiaries | 6876 |
| Total Submitted Charge Amount | 1060564 |
| Total Medicare Allowed Amount | 307905.17 |
| Total Medicare Payment Amount | 236863.4 |
| Total Medicare Standardized Payment Amount | 245652.92 |
| 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 | 178 |
| Number Of Medical Services | 10984 |
| Number Of Medicare Beneficiaries With Medical Services | 6876 |
| Total Medical Submitted Charge Amount | 1060564 |
| Total Medical Medicare Allowed Amount | 307905.17 |
| Total Medical Medicare Payment Amount | 236863.4 |
| Total Medical Medicare Standardized Payment Amount | 245652.92 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1617 |
| Number Of Beneficiaries Age 65 to 74 | 2434 |
| Number Of Beneficiaries Age 75 to 84 | 1845 |
| Number Of Beneficiaries Age Greater 84 | 980 |
| Number Of Female Beneficiaries | 4135 |
| Number Of Male Beneficiaries | 2741 |
| Number Of Non Hispanic White Beneficiaries | 6474 |
| Number Of Black or African American Beneficiaries | 301 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4370 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2506 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5905 |