| National Provider Identifier [NPI]: | 1285695940 |
| Last Name Of The Provider | HURLBUT-MILLER |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4400 SOUTH 700 EAST |
| Street Address 2 Of The Provider | STE 200 |
| City Of The Provider | SALT LAKE CITY |
| Zip Code Of The Provider | 84107 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 13048 |
| Number Of Medicare Beneficiaries | 878 |
| Total Submitted Charge Amount | 6750169 |
| Total Medicare Allowed Amount | 3916228.58 |
| Total Medicare Payment Amount | 3013380.78 |
| Total Medicare Standardized Payment Amount | 3018164.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 8209 |
| Number Of Medicare Beneficiaries With Drug Services | 397 |
| Total Drug Submitted ChargeAmount | 4686345 |
| Total Drug Medicare AllowedAmount | 3390585.99 |
| Total Drug Medicare PaymentAmount | 2627842.42 |
| Total Drug Medicare Standardized Payment Amount | 2627842.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 4839 |
| Number Of Medicare Beneficiaries With Medical Services | 877 |
| Total Medical Submitted Charge Amount | 2063824 |
| Total Medical Medicare Allowed Amount | 525642.59 |
| Total Medical Medicare Payment Amount | 385538.36 |
| Total Medical Medicare Standardized Payment Amount | 390322.51 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 276 |
| Number Of Beneficiaries Age 75 to 84 | 318 |
| Number Of Beneficiaries Age Greater 84 | 240 |
| Number Of Female Beneficiaries | 534 |
| Number Of Male Beneficiaries | 344 |
| Number Of Non Hispanic White Beneficiaries | 811 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 819 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.2861 |