| National Provider Identifier [NPI]: | 1164495115 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 241 CORPORATE BLVD |
| Street Address 2 Of The Provider | SUITE 215 |
| City Of The Provider | NORFOLK |
| Zip Code Of The Provider | 235024954 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 3853 |
| Number Of Medicare Beneficiaries | 980 |
| Total Submitted Charge Amount | 1633656.59 |
| Total Medicare Allowed Amount | 1191260.8 |
| Total Medicare Payment Amount | 922962.77 |
| Total Medicare Standardized Payment Amount | 870082.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 106 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 636 |
| Total Drug Medicare AllowedAmount | 189.28 |
| Total Drug Medicare PaymentAmount | 126.93 |
| Total Drug Medicare Standardized Payment Amount | 126.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 3747 |
| Number Of Medicare Beneficiaries With Medical Services | 980 |
| Total Medical Submitted Charge Amount | 1633020.59 |
| Total Medical Medicare Allowed Amount | 1191071.52 |
| Total Medical Medicare Payment Amount | 922835.84 |
| Total Medical Medicare Standardized Payment Amount | 869955.47 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 403 |
| Number Of Beneficiaries Age 75 to 84 | 393 |
| Number Of Beneficiaries Age Greater 84 | 164 |
| Number Of Female Beneficiaries | 403 |
| Number Of Male Beneficiaries | 577 |
| Number Of Non Hispanic White Beneficiaries | 932 |
| Number Of Black or African American Beneficiaries | 24 |
| 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 | 945 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 35 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1219 |