| National Provider Identifier [NPI]: | 1508020769 |
| Last Name Of The Provider | PETERLIN |
| First Name Of The Provider | STACY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | CANP/CFNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 SIXTH AVE N |
| Street Address 2 Of The Provider | CENTRACARE CLINIC |
| City Of The Provider | ST CLOUD |
| Zip Code Of The Provider | 563032735 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 953 |
| Number Of Medicare Beneficiaries | 428 |
| Total Submitted Charge Amount | 141927.25 |
| Total Medicare Allowed Amount | 50274.42 |
| Total Medicare Payment Amount | 35910.93 |
| Total Medicare Standardized Payment Amount | 43530.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 51 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 1627.25 |
| Total Drug Medicare AllowedAmount | 906.84 |
| Total Drug Medicare PaymentAmount | 880.94 |
| Total Drug Medicare Standardized Payment Amount | 880.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 902 |
| Number Of Medicare Beneficiaries With Medical Services | 428 |
| Total Medical Submitted Charge Amount | 140300 |
| Total Medical Medicare Allowed Amount | 49367.58 |
| Total Medical Medicare Payment Amount | 35029.99 |
| Total Medical Medicare Standardized Payment Amount | 42649.2 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 144 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 296 |
| Number Of Male Beneficiaries | 132 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 367 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.434 |