| National Provider Identifier [NPI]: | 1801038476 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 723 PARK RIDGE LANE |
| Street Address 2 Of The Provider | |
| City Of The Provider | N FOND DU LAC |
| Zip Code Of The Provider | 549371385 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 580 |
| Number Of Medicare Beneficiaries | 241 |
| Total Submitted Charge Amount | 115429 |
| Total Medicare Allowed Amount | 42004.77 |
| Total Medicare Payment Amount | 28765.6 |
| Total Medicare Standardized Payment Amount | 31732.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 73 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 1597 |
| Total Drug Medicare AllowedAmount | 726.23 |
| Total Drug Medicare PaymentAmount | 631.09 |
| Total Drug Medicare Standardized Payment Amount | 631.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 507 |
| Number Of Medicare Beneficiaries With Medical Services | 241 |
| Total Medical Submitted Charge Amount | 113832 |
| Total Medical Medicare Allowed Amount | 41278.54 |
| Total Medical Medicare Payment Amount | 28134.51 |
| Total Medical Medicare Standardized Payment Amount | 31101.75 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 94 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 49 |
| Number Of Female Beneficiaries | 137 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 195 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2918 |