| National Provider Identifier [NPI]: | 1932194263 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12554 RIATA VISTA CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUSTIN |
| Zip Code Of The Provider | 787276431 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 6550 |
| Number Of Medicare Beneficiaries | 3580 |
| Total Submitted Charge Amount | 590759.1 |
| Total Medicare Allowed Amount | 162667.44 |
| Total Medicare Payment Amount | 121587.44 |
| Total Medicare Standardized Payment Amount | 124914.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1396 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 2906.6 |
| Total Drug Medicare AllowedAmount | 952.29 |
| Total Drug Medicare PaymentAmount | 746.59 |
| Total Drug Medicare Standardized Payment Amount | 746.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 173 |
| Number Of Medical Services | 5154 |
| Number Of Medicare Beneficiaries With Medical Services | 3580 |
| Total Medical Submitted Charge Amount | 587852.5 |
| Total Medical Medicare Allowed Amount | 161715.15 |
| Total Medical Medicare Payment Amount | 120840.85 |
| Total Medical Medicare Standardized Payment Amount | 124168.23 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 607 |
| Number Of Beneficiaries Age 65 to 74 | 1355 |
| Number Of Beneficiaries Age 75 to 84 | 1039 |
| Number Of Beneficiaries Age Greater 84 | 579 |
| Number Of Female Beneficiaries | 2168 |
| Number Of Male Beneficiaries | 1412 |
| Number Of Non Hispanic White Beneficiaries | 2679 |
| Number Of Black or African American Beneficiaries | 373 |
| Number Of AsianPacific Islander Beneficiaries | 72 |
| Number Of Hispanic Beneficiaries | 417 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2779 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 801 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.9179 |