| National Provider Identifier [NPI]: | 1578531034 |
| Last Name Of The Provider | LOEWENSON |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2425 CHICAGO AVENUE SOUTH |
| Street Address 2 Of The Provider | CHILDRENS PRIMARY CLINIC - TAMS |
| City Of The Provider | MINNEAPOLIS |
| Zip Code Of The Provider | 55404 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 202 |
| Number Of Medicare Beneficiaries | 65 |
| Total Submitted Charge Amount | 3596 |
| Total Medicare Allowed Amount | 2159.61 |
| Total Medicare Payment Amount | 2043.31 |
| Total Medicare Standardized Payment Amount | 2106.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 813 |
| Total Drug Medicare AllowedAmount | 566.59 |
| Total Drug Medicare PaymentAmount | 548.13 |
| Total Drug Medicare Standardized Payment Amount | 548.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 166 |
| Number Of Medicare Beneficiaries With Medical Services | 64 |
| Total Medical Submitted Charge Amount | 2783 |
| Total Medical Medicare Allowed Amount | 1593.02 |
| Total Medical Medicare Payment Amount | 1495.18 |
| Total Medical Medicare Standardized Payment Amount | 1558.43 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 20 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 30 |
| Number Of Male Beneficiaries | 35 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0585 |