| National Provider Identifier [NPI]: | 1841204971 |
| Last Name Of The Provider | PEDDICORD |
| First Name Of The Provider | RANDOLPH |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1201 SE INDIAN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | STUART |
| Zip Code Of The Provider | 349975688 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 997 |
| Number Of Medicare Beneficiaries | 382 |
| Total Submitted Charge Amount | 275121 |
| Total Medicare Allowed Amount | 93659.33 |
| Total Medicare Payment Amount | 72635.69 |
| Total Medicare Standardized Payment Amount | 69240.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 973 |
| Total Drug Medicare AllowedAmount | 162.34 |
| Total Drug Medicare PaymentAmount | 132.8 |
| Total Drug Medicare Standardized Payment Amount | 132.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 970 |
| Number Of Medicare Beneficiaries With Medical Services | 381 |
| Total Medical Submitted Charge Amount | 274148 |
| Total Medical Medicare Allowed Amount | 93496.99 |
| Total Medical Medicare Payment Amount | 72502.89 |
| Total Medical Medicare Standardized Payment Amount | 69107.76 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 124 |
| Number Of Beneficiaries Age 65 to 74 | 120 |
| Number Of Beneficiaries Age 75 to 84 | 74 |
| Number Of Beneficiaries Age Greater 84 | 64 |
| Number Of Female Beneficiaries | 208 |
| Number Of Male Beneficiaries | 174 |
| Number Of Non Hispanic White Beneficiaries | 350 |
| Number Of Black or African American Beneficiaries | 18 |
| 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 | 280 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 102 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.2016 |