| National Provider Identifier [NPI]: | 1992907364 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | BRADFORD |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6545 FRANCE AVE S |
| Street Address 2 Of The Provider | SUITE 150 |
| City Of The Provider | EDINA |
| Zip Code Of The Provider | 554352131 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Preventive Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 106 |
| Number Of Services | 3691 |
| Number Of Medicare Beneficiaries | 293 |
| Total Submitted Charge Amount | 326719.86 |
| Total Medicare Allowed Amount | 148591.88 |
| Total Medicare Payment Amount | 116650.88 |
| Total Medicare Standardized Payment Amount | 120084.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 472 |
| Number Of Medicare Beneficiaries With Drug Services | 152 |
| Total Drug Submitted ChargeAmount | 28436.86 |
| Total Drug Medicare AllowedAmount | 20292.77 |
| Total Drug Medicare PaymentAmount | 19423.06 |
| Total Drug Medicare Standardized Payment Amount | 19423.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 96 |
| Number Of Medical Services | 3219 |
| Number Of Medicare Beneficiaries With Medical Services | 292 |
| Total Medical Submitted Charge Amount | 298283 |
| Total Medical Medicare Allowed Amount | 128299.11 |
| Total Medical Medicare Payment Amount | 97227.82 |
| Total Medical Medicare Standardized Payment Amount | 100661.86 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 61 |
| Number Of Beneficiaries Age 75 to 84 | 90 |
| Number Of Beneficiaries Age Greater 84 | 101 |
| Number Of Female Beneficiaries | 122 |
| Number Of Male Beneficiaries | 171 |
| Number Of Non Hispanic White Beneficiaries | 266 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 252 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3814 |