| National Provider Identifier [NPI]: | 1558593731 |
| Last Name Of The Provider | PETERS |
| First Name Of The Provider | ROXANNE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 508 STOCKTRAIL AVE STE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | GILLETTE |
| Zip Code Of The Provider | 827163582 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 2681 |
| Number Of Medicare Beneficiaries | 398 |
| Total Submitted Charge Amount | 137311.13 |
| Total Medicare Allowed Amount | 57515.58 |
| Total Medicare Payment Amount | 41748.78 |
| Total Medicare Standardized Payment Amount | 47116.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 1874 |
| Number Of Medicare Beneficiaries With Drug Services | 138 |
| Total Drug Submitted ChargeAmount | 39856.36 |
| Total Drug Medicare AllowedAmount | 15233.92 |
| Total Drug Medicare PaymentAmount | 11898.55 |
| Total Drug Medicare Standardized Payment Amount | 11898.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 807 |
| Number Of Medicare Beneficiaries With Medical Services | 398 |
| Total Medical Submitted Charge Amount | 97454.77 |
| Total Medical Medicare Allowed Amount | 42281.66 |
| Total Medical Medicare Payment Amount | 29850.23 |
| Total Medical Medicare Standardized Payment Amount | 35218.12 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 172 |
| Number Of Beneficiaries Age 75 to 84 | 124 |
| Number Of Beneficiaries Age Greater 84 | 55 |
| Number Of Female Beneficiaries | 238 |
| Number Of Male Beneficiaries | 160 |
| Number Of Non Hispanic White Beneficiaries | 384 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 349 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| 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 | 17 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9493 |