| National Provider Identifier [NPI]: | 1326000241 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | DEBRA |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 520 SOUTH SIBLEY AVE |
| Street Address 2 Of The Provider | AFFILIATED COMMUNITY MEDICAL CENTERS |
| City Of The Provider | LITCHFIELD |
| Zip Code Of The Provider | 55355 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 440 |
| Number Of Medicare Beneficiaries | 67 |
| Total Submitted Charge Amount | 20446.7 |
| Total Medicare Allowed Amount | 7464.83 |
| Total Medicare Payment Amount | 5868.94 |
| Total Medicare Standardized Payment Amount | 6096.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 237 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 1192.65 |
| Total Drug Medicare AllowedAmount | 240.69 |
| Total Drug Medicare PaymentAmount | 209.8 |
| Total Drug Medicare Standardized Payment Amount | 209.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 203 |
| Number Of Medicare Beneficiaries With Medical Services | 67 |
| Total Medical Submitted Charge Amount | 19254.05 |
| Total Medical Medicare Allowed Amount | 7224.14 |
| Total Medical Medicare Payment Amount | 5659.14 |
| Total Medical Medicare Standardized Payment Amount | 5886.7 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 41 |
| Number Of Male Beneficiaries | 26 |
| Number Of Non Hispanic White Beneficiaries | 67 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 46 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 19 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4145 |