| National Provider Identifier [NPI]: | 1194702597 |
| Last Name Of The Provider | DIEDRICHSEN |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3772 43RD AVE |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 686011681 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 5838 |
| Number Of Medicare Beneficiaries | 1682 |
| Total Submitted Charge Amount | 2126396 |
| Total Medicare Allowed Amount | 1045506.35 |
| Total Medicare Payment Amount | 800550.59 |
| Total Medicare Standardized Payment Amount | 842490.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 692 |
| Number Of Medicare Beneficiaries With Drug Services | 53 |
| Total Drug Submitted ChargeAmount | 323596 |
| Total Drug Medicare AllowedAmount | 292094.6 |
| Total Drug Medicare PaymentAmount | 228634.76 |
| Total Drug Medicare Standardized Payment Amount | 228634.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 5146 |
| Number Of Medicare Beneficiaries With Medical Services | 1682 |
| Total Medical Submitted Charge Amount | 1802800 |
| Total Medical Medicare Allowed Amount | 753411.75 |
| Total Medical Medicare Payment Amount | 571915.83 |
| Total Medical Medicare Standardized Payment Amount | 613855.37 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 507 |
| Number Of Beneficiaries Age 75 to 84 | 740 |
| Number Of Beneficiaries Age Greater 84 | 392 |
| Number Of Female Beneficiaries | 1049 |
| Number Of Male Beneficiaries | 633 |
| Number Of Non Hispanic White Beneficiaries | 1663 |
| 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 | 1554 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 128 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9561 |