| National Provider Identifier [NPI]: | 1487697538 |
| Last Name Of The Provider | PEEK |
| First Name Of The Provider | STACEY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 PINE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TEXARKANA |
| Zip Code Of The Provider | 755015100 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 883 |
| Number Of Medicare Beneficiaries | 416 |
| Total Submitted Charge Amount | 173669 |
| Total Medicare Allowed Amount | 46351.62 |
| Total Medicare Payment Amount | 32640.53 |
| Total Medicare Standardized Payment Amount | 40709.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 168 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 3428 |
| Total Drug Medicare AllowedAmount | 160.45 |
| Total Drug Medicare PaymentAmount | 80.17 |
| Total Drug Medicare Standardized Payment Amount | 80.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 715 |
| Number Of Medicare Beneficiaries With Medical Services | 416 |
| Total Medical Submitted Charge Amount | 170241 |
| Total Medical Medicare Allowed Amount | 46191.17 |
| Total Medical Medicare Payment Amount | 32560.36 |
| Total Medical Medicare Standardized Payment Amount | 40629.72 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 134 |
| Number Of Beneficiaries Age 65 to 74 | 146 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 260 |
| Number Of Male Beneficiaries | 156 |
| Number Of Non Hispanic White Beneficiaries | 304 |
| Number Of Black or African American Beneficiaries | 99 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 236 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 180 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5536 |