| National Provider Identifier [NPI]: | 1013924174 |
| Last Name Of The Provider | PELT |
| First Name Of The Provider | ALAN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | OD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4340 LAFAYETTE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARIANNA |
| Zip Code Of The Provider | 32446 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 1773 |
| Number Of Medicare Beneficiaries | 769 |
| Total Submitted Charge Amount | 193405 |
| Total Medicare Allowed Amount | 153245.31 |
| Total Medicare Payment Amount | 106532.34 |
| Total Medicare Standardized Payment Amount | 108601.1 |
| 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 | 16 |
| Number Of Medical Services | 1773 |
| Number Of Medicare Beneficiaries With Medical Services | 769 |
| Total Medical Submitted Charge Amount | 193405 |
| Total Medical Medicare Allowed Amount | 153245.31 |
| Total Medical Medicare Payment Amount | 106532.34 |
| Total Medical Medicare Standardized Payment Amount | 108601.1 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 130 |
| Number Of Beneficiaries Age 65 to 74 | 288 |
| Number Of Beneficiaries Age 75 to 84 | 233 |
| Number Of Beneficiaries Age Greater 84 | 118 |
| Number Of Female Beneficiaries | 477 |
| Number Of Male Beneficiaries | 292 |
| Number Of Non Hispanic White Beneficiaries | 625 |
| 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 | 501 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 268 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1822 |