| National Provider Identifier [NPI]: | 1588635544 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 677 N WILMOT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUCSON |
| Zip Code Of The Provider | 857112701 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 132 |
| Number Of Services | 33945 |
| Number Of Medicare Beneficiaries | 2455 |
| Total Submitted Charge Amount | 1414282 |
| Total Medicare Allowed Amount | 371793.87 |
| Total Medicare Payment Amount | 281086.15 |
| Total Medicare Standardized Payment Amount | 289116.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 30838 |
| Number Of Medicare Beneficiaries With Drug Services | 445 |
| Total Drug Submitted ChargeAmount | 49713 |
| Total Drug Medicare AllowedAmount | 12651.96 |
| Total Drug Medicare PaymentAmount | 9842.47 |
| Total Drug Medicare Standardized Payment Amount | 9842.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 129 |
| Number Of Medical Services | 3107 |
| Number Of Medicare Beneficiaries With Medical Services | 2455 |
| Total Medical Submitted Charge Amount | 1364569 |
| Total Medical Medicare Allowed Amount | 359141.91 |
| Total Medical Medicare Payment Amount | 271243.68 |
| Total Medical Medicare Standardized Payment Amount | 279273.84 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 236 |
| Number Of Beneficiaries Age 65 to 74 | 1048 |
| Number Of Beneficiaries Age 75 to 84 | 797 |
| Number Of Beneficiaries Age Greater 84 | 374 |
| Number Of Female Beneficiaries | 1423 |
| Number Of Male Beneficiaries | 1032 |
| Number Of Non Hispanic White Beneficiaries | 2146 |
| Number Of Black or African American Beneficiaries | 57 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 180 |
| Number Of American Indian Alaska Native Beneficiaries | 17 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2178 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 277 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4182 |