| National Provider Identifier [NPI]: | 1215991328 |
| Last Name Of The Provider | HODGES |
| First Name Of The Provider | ALTA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 133 BROOKLINE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 022153904 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 212 |
| Number Of Medicare Beneficiaries | 65 |
| Total Submitted Charge Amount | 7261 |
| Total Medicare Allowed Amount | 4773.32 |
| Total Medicare Payment Amount | 3439.63 |
| Total Medicare Standardized Payment Amount | 3733.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 61 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 262 |
| Total Drug Medicare AllowedAmount | 47.82 |
| Total Drug Medicare PaymentAmount | 36.29 |
| Total Drug Medicare Standardized Payment Amount | 36.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 151 |
| Number Of Medicare Beneficiaries With Medical Services | 62 |
| Total Medical Submitted Charge Amount | 6999 |
| Total Medical Medicare Allowed Amount | 4725.5 |
| Total Medical Medicare Payment Amount | 3403.34 |
| Total Medical Medicare Standardized Payment Amount | 3697.08 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 30 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 43 |
| Number Of Male Beneficiaries | 22 |
| Number Of Non Hispanic White Beneficiaries | 40 |
| 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 | 41 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1866 |