| National Provider Identifier [NPI]: | 1003892720 |
| Last Name Of The Provider | PEDERSEN |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 602 KNOX ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BARBOURVILLE |
| Zip Code Of The Provider | 409061304 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 3269 |
| Number Of Medicare Beneficiaries | 555 |
| Total Submitted Charge Amount | 396457 |
| Total Medicare Allowed Amount | 166758.22 |
| Total Medicare Payment Amount | 110708.22 |
| Total Medicare Standardized Payment Amount | 121922.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 433 |
| Number Of Medicare Beneficiaries With Drug Services | 257 |
| Total Drug Submitted ChargeAmount | 16011 |
| Total Drug Medicare AllowedAmount | 9288.78 |
| Total Drug Medicare PaymentAmount | 8846.58 |
| Total Drug Medicare Standardized Payment Amount | 8846.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 2836 |
| Number Of Medicare Beneficiaries With Medical Services | 555 |
| Total Medical Submitted Charge Amount | 380446 |
| Total Medical Medicare Allowed Amount | 157469.44 |
| Total Medical Medicare Payment Amount | 101861.64 |
| Total Medical Medicare Standardized Payment Amount | 113076.3 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 174 |
| Number Of Beneficiaries Age 65 to 74 | 212 |
| Number Of Beneficiaries Age 75 to 84 | 134 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 304 |
| Number Of Male Beneficiaries | 251 |
| Number Of Non Hispanic White Beneficiaries | 541 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 266 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 289 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1209 |