| National Provider Identifier [NPI]: | 1326160748 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | PROVIDER ENROLLMENT |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Radiation Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 1583 |
| Number Of Medicare Beneficiaries | 122 |
| Total Submitted Charge Amount | 372523.34 |
| Total Medicare Allowed Amount | 277325.47 |
| Total Medicare Payment Amount | 216151.25 |
| Total Medicare Standardized Payment Amount | 225314.46 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 59 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 106 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 36 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.7389 |