| National Provider Identifier [NPI]: | 1336142934 |
| Last Name Of The Provider | HOLLINGSWORTH |
| First Name Of The Provider | LATICIA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | P.A.-C, ATC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 106 BLANCA AVE |
| Street Address 2 Of The Provider | ORTHOPEDIC DEPARTMENT |
| City Of The Provider | ALAMOSA |
| Zip Code Of The Provider | 811012340 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 1025 |
| Number Of Medicare Beneficiaries | 185 |
| Total Submitted Charge Amount | 95901.29 |
| Total Medicare Allowed Amount | 33848.05 |
| Total Medicare Payment Amount | 25125.66 |
| Total Medicare Standardized Payment Amount | 29008.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 659 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 32705.29 |
| Total Drug Medicare AllowedAmount | 6711.36 |
| Total Drug Medicare PaymentAmount | 5252.83 |
| Total Drug Medicare Standardized Payment Amount | 5252.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 366 |
| Number Of Medicare Beneficiaries With Medical Services | 185 |
| Total Medical Submitted Charge Amount | 63196 |
| Total Medical Medicare Allowed Amount | 27136.69 |
| Total Medical Medicare Payment Amount | 19872.83 |
| Total Medical Medicare Standardized Payment Amount | 23755.84 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 76 |
| Number Of Beneficiaries Age 75 to 84 | 45 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 114 |
| Number Of Male Beneficiaries | 71 |
| Number Of Non Hispanic White Beneficiaries | 105 |
| 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 | 121 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 64 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 66 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9477 |