| National Provider Identifier [NPI]: | 1508970757 |
| Last Name Of The Provider | PETERS |
| First Name Of The Provider | LIDIA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 ROUTE 522 |
| Street Address 2 Of The Provider | SELINSGROVE CENTER |
| City Of The Provider | SELINGSGROVE |
| Zip Code Of The Provider | 178708707 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 514 |
| Number Of Medicare Beneficiaries | 126 |
| Total Submitted Charge Amount | 28558.19 |
| Total Medicare Allowed Amount | 27928.04 |
| Total Medicare Payment Amount | 21480.84 |
| Total Medicare Standardized Payment Amount | 22629.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 81 |
| Number Of Medicare Beneficiaries With Drug Services | 81 |
| Total Drug Submitted ChargeAmount | 1247.4 |
| Total Drug Medicare AllowedAmount | 1247.4 |
| Total Drug Medicare PaymentAmount | 1222.29 |
| Total Drug Medicare Standardized Payment Amount | 1222.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 433 |
| Number Of Medicare Beneficiaries With Medical Services | 126 |
| Total Medical Submitted Charge Amount | 27310.79 |
| Total Medical Medicare Allowed Amount | 26680.64 |
| Total Medical Medicare Payment Amount | 20258.55 |
| Total Medical Medicare Standardized Payment Amount | 21407.35 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 38 |
| Number Of Male Beneficiaries | 88 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 126 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 13 |
| Percent Of With Ischemic Heart Disease | 10 |
| Percent Of With Osteoporosis | 75 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 10 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 34 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.6049 |