| National Provider Identifier [NPI]: | 1760472039 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | WALLACE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 201 S 68TH STREET PL |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | LINCOLN |
| Zip Code Of The Provider | 685102496 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 166 |
| Number Of Services | 293319 |
| Number Of Medicare Beneficiaries | 1426 |
| Total Submitted Charge Amount | 10513243.9 |
| Total Medicare Allowed Amount | 4639989.62 |
| Total Medicare Payment Amount | 3620785.75 |
| Total Medicare Standardized Payment Amount | 3679905.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 84 |
| Number Of Drug Services | 271006 |
| Number Of Medicare Beneficiaries With Drug Services | 583 |
| Total Drug Submitted ChargeAmount | 7719646.9 |
| Total Drug Medicare AllowedAmount | 3645790.69 |
| Total Drug Medicare PaymentAmount | 2842403.94 |
| Total Drug Medicare Standardized Payment Amount | 2842403.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 22313 |
| Number Of Medicare Beneficiaries With Medical Services | 1426 |
| Total Medical Submitted Charge Amount | 2793597 |
| Total Medical Medicare Allowed Amount | 994198.93 |
| Total Medical Medicare Payment Amount | 778381.81 |
| Total Medical Medicare Standardized Payment Amount | 837501.41 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 110 |
| Number Of Beneficiaries Age 65 to 74 | 606 |
| Number Of Beneficiaries Age 75 to 84 | 519 |
| Number Of Beneficiaries Age Greater 84 | 191 |
| Number Of Female Beneficiaries | 812 |
| Number Of Male Beneficiaries | 614 |
| Number Of Non Hispanic White Beneficiaries | 1367 |
| Number Of Black or African American Beneficiaries | 20 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1264 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 162 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 52 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.8148 |