| National Provider Identifier [NPI]: | 1477508935 |
| Last Name Of The Provider | KOTTRA |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 77 W. FOREST AVENUE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | FLAGSTAFF |
| Zip Code Of The Provider | 860011482 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 194 |
| Number Of Services | 8283 |
| Number Of Medicare Beneficiaries | 2215 |
| Total Submitted Charge Amount | 1244197.34 |
| Total Medicare Allowed Amount | 321750.73 |
| Total Medicare Payment Amount | 253599.51 |
| Total Medicare Standardized Payment Amount | 258328.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 4581 |
| Number Of Medicare Beneficiaries With Drug Services | 87 |
| Total Drug Submitted ChargeAmount | 6763.6 |
| Total Drug Medicare AllowedAmount | 2151.97 |
| Total Drug Medicare PaymentAmount | 1687.13 |
| Total Drug Medicare Standardized Payment Amount | 1687.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 188 |
| Number Of Medical Services | 3702 |
| Number Of Medicare Beneficiaries With Medical Services | 2213 |
| Total Medical Submitted Charge Amount | 1237433.74 |
| Total Medical Medicare Allowed Amount | 319598.76 |
| Total Medical Medicare Payment Amount | 251912.38 |
| Total Medical Medicare Standardized Payment Amount | 256641.73 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 278 |
| Number Of Beneficiaries Age 65 to 74 | 1110 |
| Number Of Beneficiaries Age 75 to 84 | 583 |
| Number Of Beneficiaries Age Greater 84 | 244 |
| Number Of Female Beneficiaries | 1371 |
| Number Of Male Beneficiaries | 844 |
| Number Of Non Hispanic White Beneficiaries | 1574 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 166 |
| Number Of American Indian Alaska Native Beneficiaries | 398 |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1678 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 537 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3442 |