| National Provider Identifier [NPI]: | 1417992033 |
| Last Name Of The Provider | FREDRIKSON |
| First Name Of The Provider | LORNA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10565 N TATUM BLVD |
| Street Address 2 Of The Provider | SUITE # B-116 |
| City Of The Provider | PARADISE VALLEY |
| Zip Code Of The Provider | 852531095 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 5521 |
| Number Of Medicare Beneficiaries | 963 |
| Total Submitted Charge Amount | 458435 |
| Total Medicare Allowed Amount | 320428.34 |
| Total Medicare Payment Amount | 235080.72 |
| Total Medicare Standardized Payment Amount | 236317.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 76 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 13465 |
| Total Drug Medicare AllowedAmount | 10241.47 |
| Total Drug Medicare PaymentAmount | 7978.13 |
| Total Drug Medicare Standardized Payment Amount | 7978.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 5445 |
| Number Of Medicare Beneficiaries With Medical Services | 963 |
| Total Medical Submitted Charge Amount | 444970 |
| Total Medical Medicare Allowed Amount | 310186.87 |
| Total Medical Medicare Payment Amount | 227102.59 |
| Total Medical Medicare Standardized Payment Amount | 228339.79 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 562 |
| Number Of Beneficiaries Age 75 to 84 | 293 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 591 |
| Number Of Male Beneficiaries | 372 |
| Number Of Non Hispanic White Beneficiaries | 938 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 2 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 8 |
| Percent Of With Diabetes | 12 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 1 |
| Average HCC Risk Score Of Beneficiaries | 0.7645 |