| National Provider Identifier [NPI]: | 1285623793 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2205 MCCALLIE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHATTANOOGA |
| Zip Code Of The Provider | 374043323 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 88 |
| Number Of Services | 6115 |
| Number Of Medicare Beneficiaries | 425 |
| Total Submitted Charge Amount | 484365 |
| Total Medicare Allowed Amount | 191652.54 |
| Total Medicare Payment Amount | 147205.2 |
| Total Medicare Standardized Payment Amount | 160003.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 584 |
| Number Of Medicare Beneficiaries With Drug Services | 175 |
| Total Drug Submitted ChargeAmount | 56595 |
| Total Drug Medicare AllowedAmount | 21461.99 |
| Total Drug Medicare PaymentAmount | 19747.24 |
| Total Drug Medicare Standardized Payment Amount | 19747.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 5531 |
| Number Of Medicare Beneficiaries With Medical Services | 425 |
| Total Medical Submitted Charge Amount | 427770 |
| Total Medical Medicare Allowed Amount | 170190.55 |
| Total Medical Medicare Payment Amount | 127457.96 |
| Total Medical Medicare Standardized Payment Amount | 140256.3 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 192 |
| Number Of Beneficiaries Age 75 to 84 | 125 |
| Number Of Beneficiaries Age Greater 84 | 67 |
| Number Of Female Beneficiaries | 258 |
| Number Of Male Beneficiaries | 167 |
| Number Of Non Hispanic White Beneficiaries | 345 |
| Number Of Black or African American Beneficiaries | 68 |
| 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 | 379 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0592 |