| National Provider Identifier [NPI]: | 1326032939 |
| Last Name Of The Provider | CANNON |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2001 S WOODRUFF AVE |
| Street Address 2 Of The Provider | SUITE 4 |
| City Of The Provider | IDAHO FALLS |
| Zip Code Of The Provider | 834046374 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 4846 |
| Number Of Medicare Beneficiaries | 999 |
| Total Submitted Charge Amount | 662210.8 |
| Total Medicare Allowed Amount | 268035.57 |
| Total Medicare Payment Amount | 198277.32 |
| Total Medicare Standardized Payment Amount | 212654.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 388 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 105171.26 |
| Total Drug Medicare AllowedAmount | 55335.01 |
| Total Drug Medicare PaymentAmount | 42565.5 |
| Total Drug Medicare Standardized Payment Amount | 42565.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 4458 |
| Number Of Medicare Beneficiaries With Medical Services | 999 |
| Total Medical Submitted Charge Amount | 557039.54 |
| Total Medical Medicare Allowed Amount | 212700.56 |
| Total Medical Medicare Payment Amount | 155711.82 |
| Total Medical Medicare Standardized Payment Amount | 170088.68 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 90 |
| Number Of Beneficiaries Age 65 to 74 | 341 |
| Number Of Beneficiaries Age 75 to 84 | 385 |
| Number Of Beneficiaries Age Greater 84 | 183 |
| Number Of Female Beneficiaries | 190 |
| Number Of Male Beneficiaries | 809 |
| Number Of Non Hispanic White Beneficiaries | 948 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 869 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 130 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1458 |