| National Provider Identifier [NPI]: | 1699794735 |
| Last Name Of The Provider | PETERSEN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1035 S MAIN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FALLBROOK |
| Zip Code Of The Provider | 920283338 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 148 |
| Number Of Services | 2725 |
| Number Of Medicare Beneficiaries | 429 |
| Total Submitted Charge Amount | 359914 |
| Total Medicare Allowed Amount | 176464.81 |
| Total Medicare Payment Amount | 132152.74 |
| Total Medicare Standardized Payment Amount | 126010.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 344 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 17589 |
| Total Drug Medicare AllowedAmount | 5122.41 |
| Total Drug Medicare PaymentAmount | 4386.16 |
| Total Drug Medicare Standardized Payment Amount | 4386.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 132 |
| Number Of Medical Services | 2381 |
| Number Of Medicare Beneficiaries With Medical Services | 429 |
| Total Medical Submitted Charge Amount | 342325 |
| Total Medical Medicare Allowed Amount | 171342.4 |
| Total Medical Medicare Payment Amount | 127766.58 |
| Total Medical Medicare Standardized Payment Amount | 121624.69 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 205 |
| Number Of Beneficiaries Age 75 to 84 | 131 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 267 |
| Number Of Male Beneficiaries | 162 |
| Number Of Non Hispanic White Beneficiaries | 379 |
| 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 | 370 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.916 |