| National Provider Identifier [NPI]: | 1043291941 |
| Last Name Of The Provider | LOTTERMAN |
| First Name Of The Provider | KATHI |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3355 EAGLE PARK DR NE |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495257004 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 675 |
| Number Of Medicare Beneficiaries | 322 |
| Total Submitted Charge Amount | 67257.56 |
| Total Medicare Allowed Amount | 48154.62 |
| Total Medicare Payment Amount | 38104.64 |
| Total Medicare Standardized Payment Amount | 45338.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 62 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 1308.56 |
| Total Drug Medicare AllowedAmount | 1212.69 |
| Total Drug Medicare PaymentAmount | 1186.9 |
| Total Drug Medicare Standardized Payment Amount | 1186.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 613 |
| Number Of Medicare Beneficiaries With Medical Services | 322 |
| Total Medical Submitted Charge Amount | 65949 |
| Total Medical Medicare Allowed Amount | 46941.93 |
| Total Medical Medicare Payment Amount | 36917.74 |
| Total Medical Medicare Standardized Payment Amount | 44152.03 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 156 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 48 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 197 |
| Number Of Male Beneficiaries | 125 |
| Number Of Non Hispanic White Beneficiaries | 263 |
| Number Of Black or African American Beneficiaries | 42 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 86 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 236 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 53 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 28 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.794 |