| National Provider Identifier [NPI]: | 1306003678 |
| Last Name Of The Provider | LODGE |
| First Name Of The Provider | KARLA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5201 N 19TH AVE |
| Street Address 2 Of The Provider | SUITE 121 |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850152951 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 259 |
| Number Of Medicare Beneficiaries | 144 |
| Total Submitted Charge Amount | 13207 |
| Total Medicare Allowed Amount | 10319.15 |
| Total Medicare Payment Amount | 7764.72 |
| Total Medicare Standardized Payment Amount | 8847.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 77 |
| Number Of Medicare Beneficiaries With Drug Services | 71 |
| Total Drug Submitted ChargeAmount | 1850 |
| Total Drug Medicare AllowedAmount | 1294.47 |
| Total Drug Medicare PaymentAmount | 1264.13 |
| Total Drug Medicare Standardized Payment Amount | 1264.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 182 |
| Number Of Medicare Beneficiaries With Medical Services | 143 |
| Total Medical Submitted Charge Amount | 11357 |
| Total Medical Medicare Allowed Amount | 9024.68 |
| Total Medical Medicare Payment Amount | 6500.59 |
| Total Medical Medicare Standardized Payment Amount | 7583.26 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | 41 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 96 |
| Number Of Male Beneficiaries | 48 |
| Number Of Non Hispanic White Beneficiaries | 129 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8558 |