| National Provider Identifier [NPI]: | 1316983513 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | GERALD |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1880 WILLAMETTE FALLS DR |
| Street Address 2 Of The Provider | SUITE 111 |
| City Of The Provider | WEST LINN |
| Zip Code Of The Provider | 970684652 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 1179 |
| Number Of Medicare Beneficiaries | 328 |
| Total Submitted Charge Amount | 188127.62 |
| Total Medicare Allowed Amount | 93271.06 |
| Total Medicare Payment Amount | 68066.91 |
| Total Medicare Standardized Payment Amount | 67908.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 18 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 252 |
| Total Drug Medicare AllowedAmount | 102.84 |
| Total Drug Medicare PaymentAmount | 76.17 |
| Total Drug Medicare Standardized Payment Amount | 76.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 1161 |
| Number Of Medicare Beneficiaries With Medical Services | 328 |
| Total Medical Submitted Charge Amount | 187875.62 |
| Total Medical Medicare Allowed Amount | 93168.22 |
| Total Medical Medicare Payment Amount | 67990.74 |
| Total Medical Medicare Standardized Payment Amount | 67832.38 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 140 |
| Number Of Beneficiaries Age 75 to 84 | 91 |
| Number Of Beneficiaries Age Greater 84 | 71 |
| Number Of Female Beneficiaries | 178 |
| Number Of Male Beneficiaries | 150 |
| 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 | 298 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2348 |