| National Provider Identifier [NPI]: | 1073886438 |
| Last Name Of The Provider | MINICH |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3124 S 19TH ST STE 240 |
| Street Address 2 Of The Provider | |
| City Of The Provider | TACOMA |
| Zip Code Of The Provider | 984052433 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 1256 |
| Number Of Medicare Beneficiaries | 375 |
| Total Submitted Charge Amount | 290947 |
| Total Medicare Allowed Amount | 121486.57 |
| Total Medicare Payment Amount | 90267.01 |
| Total Medicare Standardized Payment Amount | 89972.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 83 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 22918 |
| Total Drug Medicare AllowedAmount | 10341.39 |
| Total Drug Medicare PaymentAmount | 7943.06 |
| Total Drug Medicare Standardized Payment Amount | 7943.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 1173 |
| Number Of Medicare Beneficiaries With Medical Services | 375 |
| Total Medical Submitted Charge Amount | 268029 |
| Total Medical Medicare Allowed Amount | 111145.18 |
| Total Medical Medicare Payment Amount | 82323.95 |
| Total Medical Medicare Standardized Payment Amount | 82029.22 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 145 |
| Number Of Beneficiaries Age 75 to 84 | 132 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 128 |
| Number Of Male Beneficiaries | 247 |
| Number Of Non Hispanic White Beneficiaries | 328 |
| Number Of Black or African American Beneficiaries | 13 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 310 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 65 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3597 |