| National Provider Identifier [NPI]: | 1225089576 |
| Last Name Of The Provider | PETERS |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8100 W 78TH ST |
| Street Address 2 Of The Provider | SUITE 230 |
| City Of The Provider | EDINA |
| Zip Code Of The Provider | 554392516 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 201 |
| Number Of Medicare Beneficiaries | 43 |
| Total Submitted Charge Amount | 24846 |
| Total Medicare Allowed Amount | 10012.96 |
| Total Medicare Payment Amount | 7114.82 |
| Total Medicare Standardized Payment Amount | 7472.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 79 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 425 |
| Total Drug Medicare AllowedAmount | 152.7 |
| Total Drug Medicare PaymentAmount | 119.77 |
| Total Drug Medicare Standardized Payment Amount | 119.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 122 |
| Number Of Medicare Beneficiaries With Medical Services | 43 |
| Total Medical Submitted Charge Amount | 24421 |
| Total Medical Medicare Allowed Amount | 9860.26 |
| Total Medical Medicare Payment Amount | 6995.05 |
| Total Medical Medicare Standardized Payment Amount | 7352.88 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 14 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 26 |
| Number Of Male Beneficiaries | 17 |
| 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 | 32 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 0 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 28 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9871 |