| National Provider Identifier [NPI]: | 1649541301 |
| Last Name Of The Provider | PEINE |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6644 E BAYWOOD AVE |
| Street Address 2 Of The Provider | BANNER BAYWOOD MEDICAL CENTER |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 85206 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 1434 |
| Number Of Medicare Beneficiaries | 533 |
| Total Submitted Charge Amount | 163902.41 |
| Total Medicare Allowed Amount | 160635.8 |
| Total Medicare Payment Amount | 123256.98 |
| Total Medicare Standardized Payment Amount | 124724.33 |
| 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 | 17 |
| Number Of Medical Services | 1434 |
| Number Of Medicare Beneficiaries With Medical Services | 533 |
| Total Medical Submitted Charge Amount | 163902.41 |
| Total Medical Medicare Allowed Amount | 160635.8 |
| Total Medical Medicare Payment Amount | 123256.98 |
| Total Medical Medicare Standardized Payment Amount | 124724.33 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 169 |
| Number Of Beneficiaries Age 75 to 84 | 197 |
| Number Of Beneficiaries Age Greater 84 | 122 |
| Number Of Female Beneficiaries | 260 |
| Number Of Male Beneficiaries | 273 |
| Number Of Non Hispanic White Beneficiaries | 505 |
| 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 | 475 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 58 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 56 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.7195 |