| National Provider Identifier [NPI]: | 1891729109 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 425 MEDICAL DR |
| Street Address 2 Of The Provider | #220 |
| City Of The Provider | BOUNTIFUL |
| Zip Code Of The Provider | 840104945 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 68 |
| Number Of Services | 8851 |
| Number Of Medicare Beneficiaries | 1060 |
| Total Submitted Charge Amount | 605613.6 |
| Total Medicare Allowed Amount | 523003.91 |
| Total Medicare Payment Amount | 383199.72 |
| Total Medicare Standardized Payment Amount | 385707.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 896 |
| Number Of Medicare Beneficiaries With Drug Services | 135 |
| Total Drug Submitted ChargeAmount | 4615.62 |
| Total Drug Medicare AllowedAmount | 4385.12 |
| Total Drug Medicare PaymentAmount | 3240.81 |
| Total Drug Medicare Standardized Payment Amount | 3240.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 7955 |
| Number Of Medicare Beneficiaries With Medical Services | 1060 |
| Total Medical Submitted Charge Amount | 600997.98 |
| Total Medical Medicare Allowed Amount | 518618.79 |
| Total Medical Medicare Payment Amount | 379958.91 |
| Total Medical Medicare Standardized Payment Amount | 382467.03 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 511 |
| Number Of Beneficiaries Age 75 to 84 | 388 |
| Number Of Beneficiaries Age Greater 84 | 116 |
| Number Of Female Beneficiaries | 440 |
| Number Of Male Beneficiaries | 620 |
| Number Of Non Hispanic White Beneficiaries | 1023 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1010 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0367 |