| National Provider Identifier [NPI]: | 1700841178 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1204 JOSEPH ST # 2 |
| Street Address 2 Of The Provider | |
| City Of The Provider | DODGEVILLE |
| Zip Code Of The Provider | 535339670 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 6006 |
| Number Of Medicare Beneficiaries | 962 |
| Total Submitted Charge Amount | 1108183.81 |
| Total Medicare Allowed Amount | 285056.25 |
| Total Medicare Payment Amount | 204005.67 |
| Total Medicare Standardized Payment Amount | 209162.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 40 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 3772 |
| Total Drug Medicare AllowedAmount | 2049.56 |
| Total Drug Medicare PaymentAmount | 1606.81 |
| Total Drug Medicare Standardized Payment Amount | 1606.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 5966 |
| Number Of Medicare Beneficiaries With Medical Services | 962 |
| Total Medical Submitted Charge Amount | 1104411.81 |
| Total Medical Medicare Allowed Amount | 283006.69 |
| Total Medical Medicare Payment Amount | 202398.86 |
| Total Medical Medicare Standardized Payment Amount | 207555.48 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 401 |
| Number Of Beneficiaries Age 75 to 84 | 356 |
| Number Of Beneficiaries Age Greater 84 | 141 |
| Number Of Female Beneficiaries | 520 |
| Number Of Male Beneficiaries | 442 |
| Number Of Non Hispanic White Beneficiaries | 945 |
| 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 | 865 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 97 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 1 |
| Average HCC Risk Score Of Beneficiaries | 0.898 |