| National Provider Identifier [NPI]: | 1902802028 |
| Last Name Of The Provider | HEDSTROM |
| First Name Of The Provider | PETER |
| 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 | 15 LOWELL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 041022748 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 7370 |
| Number Of Medicare Beneficiaries | 1517 |
| Total Submitted Charge Amount | 3470323 |
| Total Medicare Allowed Amount | 1993969.46 |
| Total Medicare Payment Amount | 1531234.19 |
| Total Medicare Standardized Payment Amount | 1528100.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 3910 |
| Number Of Medicare Beneficiaries With Drug Services | 124 |
| Total Drug Submitted ChargeAmount | 2500030 |
| Total Drug Medicare AllowedAmount | 1607857.09 |
| Total Drug Medicare PaymentAmount | 1259290.17 |
| Total Drug Medicare Standardized Payment Amount | 1259290.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 3460 |
| Number Of Medicare Beneficiaries With Medical Services | 1517 |
| Total Medical Submitted Charge Amount | 970293 |
| Total Medical Medicare Allowed Amount | 386112.37 |
| Total Medical Medicare Payment Amount | 271944.02 |
| Total Medical Medicare Standardized Payment Amount | 268810.53 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 139 |
| Number Of Beneficiaries Age 65 to 74 | 470 |
| Number Of Beneficiaries Age 75 to 84 | 565 |
| Number Of Beneficiaries Age Greater 84 | 343 |
| Number Of Female Beneficiaries | 864 |
| Number Of Male Beneficiaries | 653 |
| Number Of Non Hispanic White Beneficiaries | 1434 |
| Number Of Black or African American Beneficiaries | 19 |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1141 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 376 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2496 |