| National Provider Identifier [NPI]: | 1164532073 |
| Last Name Of The Provider | PETERSON |
| First Name Of The Provider | DENNIS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D.P.C. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 415 MEDICAL DR |
| Street Address 2 Of The Provider | SUITE B200 |
| City Of The Provider | BOUNTIFUL |
| Zip Code Of The Provider | 840104946 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 1152 |
| Number Of Medicare Beneficiaries | 287 |
| Total Submitted Charge Amount | 111953 |
| Total Medicare Allowed Amount | 75273.22 |
| Total Medicare Payment Amount | 54658.85 |
| Total Medicare Standardized Payment Amount | 57350.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 106 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 3005 |
| Total Drug Medicare AllowedAmount | 2170.43 |
| Total Drug Medicare PaymentAmount | 1915.16 |
| Total Drug Medicare Standardized Payment Amount | 1915.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 1046 |
| Number Of Medicare Beneficiaries With Medical Services | 287 |
| Total Medical Submitted Charge Amount | 108948 |
| Total Medical Medicare Allowed Amount | 73102.79 |
| Total Medical Medicare Payment Amount | 52743.69 |
| Total Medical Medicare Standardized Payment Amount | 55435.82 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 161 |
| Number Of Beneficiaries Age 75 to 84 | 81 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 146 |
| Number Of Male Beneficiaries | 141 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 27 |
| Percent Of With Hypertension | 30 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8298 |