| National Provider Identifier [NPI]: | 1144322504 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 965 US HWY 431 |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROANOKE |
| Zip Code Of The Provider | 36274 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 126 |
| Number Of Services | 11260 |
| Number Of Medicare Beneficiaries | 771 |
| Total Submitted Charge Amount | 588889.28 |
| Total Medicare Allowed Amount | 412000.97 |
| Total Medicare Payment Amount | 285249.54 |
| Total Medicare Standardized Payment Amount | 315005.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 3953 |
| Number Of Medicare Beneficiaries With Drug Services | 372 |
| Total Drug Submitted ChargeAmount | 21196.8 |
| Total Drug Medicare AllowedAmount | 5637.37 |
| Total Drug Medicare PaymentAmount | 4507.05 |
| Total Drug Medicare Standardized Payment Amount | 4507.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 113 |
| Number Of Medical Services | 7307 |
| Number Of Medicare Beneficiaries With Medical Services | 771 |
| Total Medical Submitted Charge Amount | 567692.48 |
| Total Medical Medicare Allowed Amount | 406363.6 |
| Total Medical Medicare Payment Amount | 280742.49 |
| Total Medical Medicare Standardized Payment Amount | 310498.12 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 266 |
| Number Of Beneficiaries Age 75 to 84 | 217 |
| Number Of Beneficiaries Age Greater 84 | 117 |
| Number Of Female Beneficiaries | 464 |
| Number Of Male Beneficiaries | 307 |
| Number Of Non Hispanic White Beneficiaries | 577 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 460 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 311 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 2 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4313 |