| National Provider Identifier [NPI]: | 1316969355 |
| Last Name Of The Provider | PETRY |
| First Name Of The Provider | GEORGE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 645 E STATE HIGHWAY 121 |
| Street Address 2 Of The Provider | SUITE 600 |
| City Of The Provider | COPPELL |
| Zip Code Of The Provider | 750197942 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 1293 |
| Number Of Medicare Beneficiaries | 303 |
| Total Submitted Charge Amount | 129393 |
| Total Medicare Allowed Amount | 59403.75 |
| Total Medicare Payment Amount | 39702.17 |
| Total Medicare Standardized Payment Amount | 44901.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 534 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 12791 |
| Total Drug Medicare AllowedAmount | 262.83 |
| Total Drug Medicare PaymentAmount | 195.25 |
| Total Drug Medicare Standardized Payment Amount | 195.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 759 |
| Number Of Medicare Beneficiaries With Medical Services | 303 |
| Total Medical Submitted Charge Amount | 116602 |
| Total Medical Medicare Allowed Amount | 59140.92 |
| Total Medical Medicare Payment Amount | 39506.92 |
| Total Medical Medicare Standardized Payment Amount | 44705.99 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 113 |
| Number Of Beneficiaries Age 75 to 84 | 74 |
| Number Of Beneficiaries Age Greater 84 | 53 |
| Number Of Female Beneficiaries | 198 |
| Number Of Male Beneficiaries | 105 |
| Number Of Non Hispanic White Beneficiaries | 248 |
| Number Of Black or African American Beneficiaries | 36 |
| 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 | 252 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9862 |