| National Provider Identifier [NPI]: | 1043524879 |
| Last Name Of The Provider | DODGE |
| First Name Of The Provider | PATRICIA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1138 BROADWAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ELMIRA |
| Zip Code Of The Provider | 149042502 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 514 |
| Number Of Medicare Beneficiaries | 221 |
| Total Submitted Charge Amount | 56370 |
| Total Medicare Allowed Amount | 31567.64 |
| Total Medicare Payment Amount | 20489.83 |
| Total Medicare Standardized Payment Amount | 26731.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 38 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 695 |
| Total Drug Medicare AllowedAmount | 353.55 |
| Total Drug Medicare PaymentAmount | 339.53 |
| Total Drug Medicare Standardized Payment Amount | 339.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 476 |
| Number Of Medicare Beneficiaries With Medical Services | 221 |
| Total Medical Submitted Charge Amount | 55675 |
| Total Medical Medicare Allowed Amount | 31214.09 |
| Total Medical Medicare Payment Amount | 20150.3 |
| Total Medical Medicare Standardized Payment Amount | 26392.11 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 81 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 152 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | 209 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 140 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 81 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2236 |