| National Provider Identifier [NPI]: | 1013973460 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | LORETTA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4001 DALE ST |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | ANCHORAGE |
| Zip Code Of The Provider | 995085445 |
| State Code Of The Provider | AK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 866 |
| Number Of Medicare Beneficiaries | 229 |
| Total Submitted Charge Amount | 150545 |
| Total Medicare Allowed Amount | 71973.18 |
| Total Medicare Payment Amount | 53605.68 |
| Total Medicare Standardized Payment Amount | 43375.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 30 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1980 |
| Total Drug Medicare AllowedAmount | 1231.13 |
| Total Drug Medicare PaymentAmount | 1199.52 |
| Total Drug Medicare Standardized Payment Amount | 1199.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 836 |
| Number Of Medicare Beneficiaries With Medical Services | 229 |
| Total Medical Submitted Charge Amount | 148565 |
| Total Medical Medicare Allowed Amount | 70742.05 |
| Total Medical Medicare Payment Amount | 52406.16 |
| Total Medical Medicare Standardized Payment Amount | 42176.33 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | 148 |
| Number Of Beneficiaries Age 75 to 84 | 52 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 183 |
| Number Of Male Beneficiaries | 46 |
| Number Of Non Hispanic White Beneficiaries | 200 |
| 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 | 216 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 7 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 11 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6809 |