| National Provider Identifier [NPI]: | 1205880861 |
| Last Name Of The Provider | PETTERSSON |
| First Name Of The Provider | L |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13640 N PLAZA DEL RIO BLVD |
| Street Address 2 Of The Provider | STE 220 |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 853814846 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 2020 |
| Number Of Medicare Beneficiaries | 492 |
| Total Submitted Charge Amount | 310477.9 |
| Total Medicare Allowed Amount | 148736.2 |
| Total Medicare Payment Amount | 100821.89 |
| Total Medicare Standardized Payment Amount | 101908.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 245 |
| Number Of Medicare Beneficiaries With Drug Services | 90 |
| Total Drug Submitted ChargeAmount | 7192.9 |
| Total Drug Medicare AllowedAmount | 4233.42 |
| Total Drug Medicare PaymentAmount | 3824.99 |
| Total Drug Medicare Standardized Payment Amount | 3824.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 1775 |
| Number Of Medicare Beneficiaries With Medical Services | 492 |
| Total Medical Submitted Charge Amount | 303285 |
| Total Medical Medicare Allowed Amount | 144502.78 |
| Total Medical Medicare Payment Amount | 96996.9 |
| Total Medical Medicare Standardized Payment Amount | 98083.07 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 201 |
| Number Of Beneficiaries Age Greater 84 | 150 |
| Number Of Female Beneficiaries | 237 |
| Number Of Male Beneficiaries | 255 |
| Number Of Non Hispanic White Beneficiaries | 475 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.035 |