| National Provider Identifier [NPI]: | 1851349179 |
| Last Name Of The Provider | PEDEN |
| First Name Of The Provider | MONTGOMERY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 PROFESSIONAL LANE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ENTERPRISE |
| Zip Code Of The Provider | 36330 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 16035 |
| Number Of Medicare Beneficiaries | 1006 |
| Total Submitted Charge Amount | 897255 |
| Total Medicare Allowed Amount | 524785.56 |
| Total Medicare Payment Amount | 384483.84 |
| Total Medicare Standardized Payment Amount | 420456.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 108 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 3258 |
| Total Drug Medicare AllowedAmount | 2324.69 |
| Total Drug Medicare PaymentAmount | 1983.39 |
| Total Drug Medicare Standardized Payment Amount | 1983.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 122 |
| Number Of Medical Services | 15927 |
| Number Of Medicare Beneficiaries With Medical Services | 1006 |
| Total Medical Submitted Charge Amount | 893997 |
| Total Medical Medicare Allowed Amount | 522460.87 |
| Total Medical Medicare Payment Amount | 382500.45 |
| Total Medical Medicare Standardized Payment Amount | 418473.31 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 105 |
| Number Of Beneficiaries Age 65 to 74 | 439 |
| Number Of Beneficiaries Age 75 to 84 | 336 |
| Number Of Beneficiaries Age Greater 84 | 126 |
| Number Of Female Beneficiaries | 547 |
| Number Of Male Beneficiaries | 459 |
| Number Of Non Hispanic White Beneficiaries | 851 |
| Number Of Black or African American Beneficiaries | 115 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 832 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 174 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9454 |