| National Provider Identifier [NPI]: | 1326012477 |
| Last Name Of The Provider | MCKENNA |
| First Name Of The Provider | LORI |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MSW LCSW |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 KENNEDY DR L6 |
| Street Address 2 Of The Provider | LORI P MCKENNA |
| City Of The Provider | SO BURLINGTON |
| Zip Code Of The Provider | 05461 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Licensed Clinical Social Worker |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 5 |
| Number Of Services | 348 |
| Number Of Medicare Beneficiaries | 147 |
| Total Submitted Charge Amount | 87178 |
| Total Medicare Allowed Amount | 25612.96 |
| Total Medicare Payment Amount | 19051.14 |
| Total Medicare Standardized Payment Amount | 19336.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 5 |
| Number Of Medical Services | 348 |
| Number Of Medicare Beneficiaries With Medical Services | 147 |
| Total Medical Submitted Charge Amount | 87178 |
| Total Medical Medicare Allowed Amount | 25612.96 |
| Total Medical Medicare Payment Amount | 19051.14 |
| Total Medical Medicare Standardized Payment Amount | 19336.2 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 49 |
| Number Of Beneficiaries Age 75 to 84 | 65 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 91 |
| Number Of Male Beneficiaries | 56 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 129 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 73 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0445 |