| National Provider Identifier [NPI]: | 1538138516 |
| Last Name Of The Provider | PETERSEN |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 801 S STEVENS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPOKANE |
| Zip Code Of The Provider | 992042654 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 154 |
| Number Of Services | 4856 |
| Number Of Medicare Beneficiaries | 2739 |
| Total Submitted Charge Amount | 562034.22 |
| Total Medicare Allowed Amount | 147073.2 |
| Total Medicare Payment Amount | 109446.88 |
| Total Medicare Standardized Payment Amount | 108975.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 708 |
| Number Of Medicare Beneficiaries With Drug Services | 74 |
| Total Drug Submitted ChargeAmount | 1893.3 |
| Total Drug Medicare AllowedAmount | 710.11 |
| Total Drug Medicare PaymentAmount | 543.62 |
| Total Drug Medicare Standardized Payment Amount | 543.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 147 |
| Number Of Medical Services | 4148 |
| Number Of Medicare Beneficiaries With Medical Services | 2737 |
| Total Medical Submitted Charge Amount | 560140.92 |
| Total Medical Medicare Allowed Amount | 146363.09 |
| Total Medical Medicare Payment Amount | 108903.26 |
| Total Medical Medicare Standardized Payment Amount | 108432.01 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 573 |
| Number Of Beneficiaries Age 65 to 74 | 1124 |
| Number Of Beneficiaries Age 75 to 84 | 728 |
| Number Of Beneficiaries Age Greater 84 | 314 |
| Number Of Female Beneficiaries | 1619 |
| Number Of Male Beneficiaries | 1120 |
| Number Of Non Hispanic White Beneficiaries | 2295 |
| Number Of Black or African American Beneficiaries | 148 |
| Number Of AsianPacific Islander Beneficiaries | 54 |
| Number Of Hispanic Beneficiaries | 174 |
| Number Of American Indian Alaska Native Beneficiaries | 33 |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2072 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 667 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4863 |