| National Provider Identifier [NPI]: | 1386663805 |
| Last Name Of The Provider | PETERSEN |
| First Name Of The Provider | DENISE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | N.P. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11234 ANDERSON ST |
| Street Address 2 Of The Provider | #1617 |
| City Of The Provider | LOMA LINDA |
| Zip Code Of The Provider | 923542804 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 8 |
| Number Of Services | 437 |
| Number Of Medicare Beneficiaries | 172 |
| Total Submitted Charge Amount | 112542 |
| Total Medicare Allowed Amount | 33491.08 |
| Total Medicare Payment Amount | 23425.48 |
| Total Medicare Standardized Payment Amount | 27035.71 |
| 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 | 8 |
| Number Of Medical Services | 437 |
| Number Of Medicare Beneficiaries With Medical Services | 172 |
| Total Medical Submitted Charge Amount | 112542 |
| Total Medical Medicare Allowed Amount | 33491.08 |
| Total Medical Medicare Payment Amount | 23425.48 |
| Total Medical Medicare Standardized Payment Amount | 27035.71 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | 61 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 63 |
| Number Of Male Beneficiaries | 109 |
| Number Of Non Hispanic White Beneficiaries | 80 |
| Number Of Black or African American Beneficiaries | 25 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 83 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 89 |
| Percent Of With Atrial Fibrillation | 37 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 75 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.4024 |