| National Provider Identifier [NPI]: | 1619954575 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6401 MOUNTAIN VIEW ROAD |
| Street Address 2 Of The Provider | SUITE 109 |
| City Of The Provider | OOLTEWAH |
| Zip Code Of The Provider | 373636685 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 6782 |
| Number Of Medicare Beneficiaries | 519 |
| Total Submitted Charge Amount | 405880 |
| Total Medicare Allowed Amount | 176661.9 |
| Total Medicare Payment Amount | 131658.34 |
| Total Medicare Standardized Payment Amount | 143042.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 1701 |
| Number Of Medicare Beneficiaries With Drug Services | 241 |
| Total Drug Submitted ChargeAmount | 33113 |
| Total Drug Medicare AllowedAmount | 6023.63 |
| Total Drug Medicare PaymentAmount | 5353.43 |
| Total Drug Medicare Standardized Payment Amount | 5353.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 5081 |
| Number Of Medicare Beneficiaries With Medical Services | 519 |
| Total Medical Submitted Charge Amount | 372767 |
| Total Medical Medicare Allowed Amount | 170638.27 |
| Total Medical Medicare Payment Amount | 126304.91 |
| Total Medical Medicare Standardized Payment Amount | 137689.11 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 236 |
| Number Of Beneficiaries Age 75 to 84 | 150 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 312 |
| Number Of Male Beneficiaries | 207 |
| Number Of Non Hispanic White Beneficiaries | 462 |
| 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 | 464 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0479 |