National Provider Identifier [NPI]: |
1770634909 |
Last Name Of The Provider |
PETERSON |
First Name Of The Provider |
MICHAEL |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
114 EAST 800 NORTH |
Street Address 2 Of The Provider |
|
City Of The Provider |
SPANISH FORK |
Zip Code Of The Provider |
84660 |
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 |
98 |
Number Of Services |
12763 |
Number Of Medicare Beneficiaries |
4086 |
Total Submitted Charge Amount |
1155849.94 |
Total Medicare Allowed Amount |
648466.29 |
Total Medicare Payment Amount |
489329.95 |
Total Medicare Standardized Payment Amount |
442305.12 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
131 |
Number Of Medicare Beneficiaries With Drug Services |
24 |
Total Drug Submitted ChargeAmount |
2737.07 |
Total Drug Medicare AllowedAmount |
2138.77 |
Total Drug Medicare PaymentAmount |
1676.77 |
Total Drug Medicare Standardized Payment Amount |
1676.77 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
93 |
Number Of Medical Services |
12632 |
Number Of Medicare Beneficiaries With Medical Services |
4086 |
Total Medical Submitted Charge Amount |
1153112.87 |
Total Medical Medicare Allowed Amount |
646327.52 |
Total Medical Medicare Payment Amount |
487653.18 |
Total Medical Medicare Standardized Payment Amount |
440628.35 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
142 |
Number Of Beneficiaries Age 65 to 74 |
1863 |
Number Of Beneficiaries Age 75 to 84 |
1530 |
Number Of Beneficiaries Age Greater 84 |
551 |
Number Of Female Beneficiaries |
1787 |
Number Of Male Beneficiaries |
2299 |
Number Of Non Hispanic White Beneficiaries |
3951 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
80 |
Number Of American Indian Alaska Native Beneficiaries |
16 |
Number Of Beneficiaries With Race Not Else where Classified |
28 |
Number Of Beneficiaries With Medicare Only Entitlement |
3830 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
256 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.0718 |