| National Provider Identifier [NPI]: | 1104810720 |
| Last Name Of The Provider | PEHOUSHEK |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD MPH |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6320-A W UNION HILLS DR. |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | GLENDALE |
| Zip Code Of The Provider | 853081051 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 12793 |
| Number Of Medicare Beneficiaries | 1428 |
| Total Submitted Charge Amount | 1208694.06 |
| Total Medicare Allowed Amount | 603953.46 |
| Total Medicare Payment Amount | 431810.51 |
| Total Medicare Standardized Payment Amount | 431366.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 360 |
| Number Of Medicare Beneficiaries With Drug Services | 118 |
| Total Drug Submitted ChargeAmount | 3635.6 |
| Total Drug Medicare AllowedAmount | 1735.77 |
| Total Drug Medicare PaymentAmount | 1326.93 |
| Total Drug Medicare Standardized Payment Amount | 1326.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 12433 |
| Number Of Medicare Beneficiaries With Medical Services | 1428 |
| Total Medical Submitted Charge Amount | 1205058.46 |
| Total Medical Medicare Allowed Amount | 602217.69 |
| Total Medical Medicare Payment Amount | 430483.58 |
| Total Medical Medicare Standardized Payment Amount | 430039.48 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 746 |
| Number Of Beneficiaries Age 75 to 84 | 447 |
| Number Of Beneficiaries Age Greater 84 | 205 |
| Number Of Female Beneficiaries | 684 |
| Number Of Male Beneficiaries | 744 |
| Number Of Non Hispanic White Beneficiaries | 1351 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1401 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9118 |