| National Provider Identifier [NPI]: | 1255303194 |
| Last Name Of The Provider | PENG |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M,D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9250 N MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WINDHAM |
| Zip Code Of The Provider | 442881058 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 512 |
| Number Of Medicare Beneficiaries | 157 |
| Total Submitted Charge Amount | 35809 |
| Total Medicare Allowed Amount | 32710.1 |
| Total Medicare Payment Amount | 20365.17 |
| Total Medicare Standardized Payment Amount | 23123.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 504 |
| Total Drug Medicare AllowedAmount | 339.18 |
| Total Drug Medicare PaymentAmount | 318.6 |
| Total Drug Medicare Standardized Payment Amount | 318.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 484 |
| Number Of Medicare Beneficiaries With Medical Services | 157 |
| Total Medical Submitted Charge Amount | 35305 |
| Total Medical Medicare Allowed Amount | 32370.92 |
| Total Medical Medicare Payment Amount | 20046.57 |
| Total Medical Medicare Standardized Payment Amount | 22804.54 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 66 |
| Number Of Beneficiaries Age 75 to 84 | 40 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 88 |
| Number Of Male Beneficiaries | 69 |
| 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 | 118 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0365 |