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NPI 1770634909 · Spanish Fork, UT · Dermatology Physician
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Michael Peterson is a dermatology physician provider located in Spanish Fork, Utah. This profile covers 35 Medicare and 3 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Michael Peterson |
| Address | 114 East 800 North |
| City | Spanish Fork |
| State | UT |
| ZIP | 84660 |
| Taxonomy | Dermatology Physician |
| NPI Enumerated | January 15, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $644.3K |
| Medicaid | $26.9K |
This provider is heavily Medicare-focused: lifetime Medicare revenue is $644.3K compared with $26.9K in Medicaid revenue, so Medicaid represents a very small portion of billed public-payer volume. The Medicaid program is present but not material to this provider’s overall revenue base.
Medicare revenue is highly concentrated in a few pathology and procedure codes: the precomputed top‑3 Medicare codes (88305, 88342, 77280) account for 48.8% of Medicare revenue, led by 88305 at $170.8K (26.8%) and 88342 at $86.3K (13.6%). On the Medicaid side the top three codes account for 100.0% of Medicaid revenue, with 99213 contributing $18.2K (67.8%) and 88305 contributing $5.8K (21.7%).
The mix of top codes indicates an office-based dermatology practice that also generates substantial pathology revenue: high-volume pathology services (88305 and 88342) sit alongside classic dermatologic procedural codes including 17311 (Mohs surgery, $41.5K), 11102 (biopsy, $22.5K) and destruction codes like 17000 and 17110. The presence of photodynamic therapy and topical agent billing (96574 and J7345) further supports a procedure-oriented dermatology service line rather than a pure primary-care practice.
Certain Medicare code volumes stand out relative to national peers. 88342 ranks #243 of 11370 providers nationally (98th percentile) and is labeled “notably above typical national volume,” and the office visit code 99213 ranks #13128 of 457151 providers nationally (97th percentile) and is also labeled “notably above typical national volume,” indicating unusually high throughput on those services compared with peers. By contrast 88305, while contributing the largest single Medicare dollar amount ($170.8K), is described as “typical, unremarkable volume” (rank #624 of 14580, 96th percentile) in our labels, suggesting strong but not exceptional relative volume for that pathology code.
Medicaid competitive standing is modest in-state: Medicaid 99213 ranks #570 of 1355 providers in-state (58th percentile) and 88305 ranks #75 of 97 (22nd percentile), each labeled “typical, unremarkable volume.” These ranks indicate the provider is a middle‑tier participant in Medicaid for common evaluation-and-management and pathology services rather than a dominant statewide Medicaid performer.
The presence of radiation-simulation and guidance codes among the top Medicare items—77280 ($53.3K, 8.4% of Medicare revenue) and G6001 ($38.9K, 6.1%)—suggests involvement with radiation planning or associated service lines uncommon for a standard dermatology-only practice. This pattern may reflect either billed services related to radiation therapy associated with the provider’s scope of care or billing under this NPI for ancillary simulation/guidance services; either way, these codes materially shape Medicare revenue mix.
With an NPI enumerated on 2007-01-15 (~19 years ago), the provider has a long tenure in the Medicare/Medicaid billing environment, which supports stability in billing patterns and relationships with payers. That longevity, combined with concentrated revenue drivers, means historical coding patterns are likely established and could be sensitive to reimbursement or policy changes for the top codes.
Because nearly half of Medicare revenue is concentrated in the top three Medicare codes (48.8%) while Medicaid revenue is nearly entirely captured by three codes (100.0%), the provider’s revenue profile is sensitive to reimbursement or utilization shifts for a small set of services. For payer contracting, audit focus, or network negotiation, this concentration implies that changes to payment policy or utilization management for 88305/88342/77280 on Medicare or 99213 on Medicaid could disproportionately affect overall revenue.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
35 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 5,020 | $30 | $170.8K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 1,140 | $80 | $86.3K |
| 77280 | The provider uses a simulator or other imaging modality to determine the size and location of ports to be used for radiation therapy. This code describes a simple level service. | 260 | $210 | $53.3K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 730 | $60 | $43K |
| 17311 | Mohs surgery is a multi–staged procedure that is performed to excise a malignant lesion layer by layer, along with histo–pathological assessment. The assessment is performed to ensure that the… | 90 | $450 | $41.5K |
| G6001 | Ultrasonic guidance for placement of radiation therapy fields | 280 | $140 | $38.9K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 470 | $70 | $31.1K |
| 11102 | The provider biopsies a single skin lesion using a tangential (side–ways) approach; he shaves off the lesion or scoops it out with a knife or curette. | 350 | $60 | $22.5K |
| 17000 | The provider destroys a premalignant lesion using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of the first or only lesion. | 560 | $30 | $18.6K |
| 17110 | The provider destroys benign lesions using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of one to 14 lesions other than skin tags or… | 230 | $80 | $17.9K |
Showing 1–10 of 35
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 35 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
35 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 17311 | 32 | 40 | 160 | $410 | $86.3K |
| G6001 | 4 | 10 | 310 | $140 | $46.7K |
| 17312 | 37 | 40 | 70 | $280 | $31.3K |
| 88305 | 2 | 150 | 360 | $40 | $23.4K |
| 77401 | 5 | 10 | 310 | $30 | $12.7K |
| 99214 | 2,490 | 4,080 | 80 | $80 | $11.6K |
| 77280 | 4 | 30 | 20 | $160 | $11.4K |
| 13132 | 26 | 40 | 40 | $200 | $10.1K |
| 17004 | 28 | 110 | 50 | $110 | $9.9K |
| J7345 | 10 | 30 | 5,600 | $1 | $9.1K |
Showing 1–10 of 35
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 270 | $70 | $18.2K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 60 | $100 | $5.8K |
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 40 | $80 | $2.8K |
How this provider's Medicaid billing volume and revenue compare to other Utah providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Utah median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 570 | 1,360 | 190 | $70 | $125K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 75 | 100 | 440 | $40 | $70.3K |
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 35 | 70 | 30 | $120 | $28.7K |
Other providers in the same ZIP code as Michael Peterson, ranked by combined Medicare and Medicaid revenue.
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