| National Provider Identifier [NPI]: | 1619968708 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 174 |
| Number Of Services | 38383 |
| Number Of Medicare Beneficiaries | 3463 |
| Total Submitted Charge Amount | 702640.18 |
| Total Medicare Allowed Amount | 534555.87 |
| Total Medicare Payment Amount | 403631.25 |
| Total Medicare Standardized Payment Amount | 439234.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 32934 |
| Number Of Medicare Beneficiaries With Drug Services | 288 |
| Total Drug Submitted ChargeAmount | 13736.54 |
| Total Drug Medicare AllowedAmount | 8466.85 |
| Total Drug Medicare PaymentAmount | 5858.95 |
| Total Drug Medicare Standardized Payment Amount | 5858.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 164 |
| Number Of Medical Services | 5449 |
| Number Of Medicare Beneficiaries With Medical Services | 3415 |
| Total Medical Submitted Charge Amount | 688903.64 |
| Total Medical Medicare Allowed Amount | 526089.02 |
| Total Medical Medicare Payment Amount | 397772.3 |
| Total Medical Medicare Standardized Payment Amount | 433375.27 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 415 |
| Number Of Beneficiaries Age 65 to 74 | 1468 |
| Number Of Beneficiaries Age 75 to 84 | 1136 |
| Number Of Beneficiaries Age Greater 84 | 444 |
| Number Of Female Beneficiaries | 1916 |
| Number Of Male Beneficiaries | 1547 |
| Number Of Non Hispanic White Beneficiaries | 3040 |
| Number Of Black or African American Beneficiaries | 208 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 103 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 64 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3235 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 228 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5951 |