| National Provider Identifier [NPI]: | 1114911831 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 W KENT AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MISSOULA |
| Zip Code Of The Provider | 598016772 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 5579 |
| Number Of Medicare Beneficiaries | 1068 |
| Total Submitted Charge Amount | 452998.78 |
| Total Medicare Allowed Amount | 436572.19 |
| Total Medicare Payment Amount | 317295.01 |
| Total Medicare Standardized Payment Amount | 301505.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3363 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 20104.2 |
| Total Drug Medicare AllowedAmount | 18447.36 |
| Total Drug Medicare PaymentAmount | 13700.88 |
| Total Drug Medicare Standardized Payment Amount | 13700.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 70 |
| Number Of Medical Services | 2216 |
| Number Of Medicare Beneficiaries With Medical Services | 1067 |
| Total Medical Submitted Charge Amount | 432894.58 |
| Total Medical Medicare Allowed Amount | 418124.83 |
| Total Medical Medicare Payment Amount | 303594.13 |
| Total Medical Medicare Standardized Payment Amount | 287804.15 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 416 |
| Number Of Beneficiaries Age 75 to 84 | 447 |
| Number Of Beneficiaries Age Greater 84 | 158 |
| Number Of Female Beneficiaries | 654 |
| Number Of Male Beneficiaries | 414 |
| Number Of Non Hispanic White Beneficiaries | 1018 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 984 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 84 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8953 |