| National Provider Identifier [NPI]: | 1346254265 |
| Last Name Of The Provider | BODLAK-HARMS |
| First Name Of The Provider | VALERIE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PA C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2725 SOUTH 144TH STREET |
| Street Address 2 Of The Provider | SUITE 212 |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681445253 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 105 |
| Number Of Medicare Beneficiaries | 28 |
| Total Submitted Charge Amount | 21076 |
| Total Medicare Allowed Amount | 4707.82 |
| Total Medicare Payment Amount | 3691.03 |
| Total Medicare Standardized Payment Amount | 3919.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 62 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 2630 |
| Total Drug Medicare AllowedAmount | 1494.16 |
| Total Drug Medicare PaymentAmount | 1171.5 |
| Total Drug Medicare Standardized Payment Amount | 1171.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 43 |
| Number Of Medicare Beneficiaries With Medical Services | 28 |
| Total Medical Submitted Charge Amount | 18446 |
| Total Medical Medicare Allowed Amount | 3213.66 |
| Total Medical Medicare Payment Amount | 2519.53 |
| Total Medical Medicare Standardized Payment Amount | 2747.71 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 17 |
| Number Of Male Beneficiaries | 11 |
| Number Of Non Hispanic White Beneficiaries | 28 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 28 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 0 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.7646 |