| National Provider Identifier [NPI]: | 1629076559 |
| Last Name Of The Provider | DODSON |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1620 9TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAST MOLINE |
| Zip Code Of The Provider | 612442120 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 1832 |
| Number Of Medicare Beneficiaries | 586 |
| Total Submitted Charge Amount | 167778 |
| Total Medicare Allowed Amount | 98636.34 |
| Total Medicare Payment Amount | 68228.73 |
| Total Medicare Standardized Payment Amount | 72743.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 51 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1530 |
| Total Drug Medicare AllowedAmount | 90.73 |
| Total Drug Medicare PaymentAmount | 67.4 |
| Total Drug Medicare Standardized Payment Amount | 67.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 1781 |
| Number Of Medicare Beneficiaries With Medical Services | 586 |
| Total Medical Submitted Charge Amount | 166248 |
| Total Medical Medicare Allowed Amount | 98545.61 |
| Total Medical Medicare Payment Amount | 68161.33 |
| Total Medical Medicare Standardized Payment Amount | 72676.23 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 195 |
| Number Of Beneficiaries Age 75 to 84 | 220 |
| Number Of Beneficiaries Age Greater 84 | 136 |
| Number Of Female Beneficiaries | 336 |
| Number Of Male Beneficiaries | 250 |
| Number Of Non Hispanic White Beneficiaries | 522 |
| Number Of Black or African American Beneficiaries | 37 |
| 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 | 537 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3954 |