| National Provider Identifier [NPI]: | 1538173190 |
| Last Name Of The Provider | PETERSON-JONES |
| First Name Of The Provider | MICHELLE |
| 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 | 11111 S 84TH ST |
| Street Address 2 Of The Provider | SUITE 2476 |
| City Of The Provider | PAPILLION |
| Zip Code Of The Provider | 680464122 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 187 |
| Number Of Services | 7315 |
| Number Of Medicare Beneficiaries | 4405 |
| Total Submitted Charge Amount | 629430 |
| Total Medicare Allowed Amount | 203161.41 |
| Total Medicare Payment Amount | 154356.7 |
| Total Medicare Standardized Payment Amount | 165027.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 187 |
| Number Of Medical Services | 7315 |
| Number Of Medicare Beneficiaries With Medical Services | 4405 |
| Total Medical Submitted Charge Amount | 629430 |
| Total Medical Medicare Allowed Amount | 203161.41 |
| Total Medical Medicare Payment Amount | 154356.7 |
| Total Medical Medicare Standardized Payment Amount | 165027.21 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 552 |
| Number Of Beneficiaries Age 65 to 74 | 1591 |
| Number Of Beneficiaries Age 75 to 84 | 1420 |
| Number Of Beneficiaries Age Greater 84 | 842 |
| Number Of Female Beneficiaries | 2682 |
| Number Of Male Beneficiaries | 1723 |
| Number Of Non Hispanic White Beneficiaries | 4260 |
| Number Of Black or African American Beneficiaries | 40 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3568 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 837 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.242 |