National Provider Identifier [NPI]: |
1760472336 |
Last Name Of The Provider |
JOHNSON |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1200 6TH AVE N |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAINT CLOUD |
Zip Code Of The Provider |
563032735 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
75 |
Number Of Services |
3484 |
Number Of Medicare Beneficiaries |
464 |
Total Submitted Charge Amount |
430748.5 |
Total Medicare Allowed Amount |
187707.95 |
Total Medicare Payment Amount |
147133.88 |
Total Medicare Standardized Payment Amount |
150343.5 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
191 |
Number Of Medicare Beneficiaries With Drug Services |
141 |
Total Drug Submitted ChargeAmount |
19721 |
Total Drug Medicare AllowedAmount |
13455.38 |
Total Drug Medicare PaymentAmount |
13069.15 |
Total Drug Medicare Standardized Payment Amount |
13069.15 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
70 |
Number Of Medical Services |
3293 |
Number Of Medicare Beneficiaries With Medical Services |
464 |
Total Medical Submitted Charge Amount |
411027.5 |
Total Medical Medicare Allowed Amount |
174252.57 |
Total Medical Medicare Payment Amount |
134064.73 |
Total Medical Medicare Standardized Payment Amount |
137274.35 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
60 |
Number Of Beneficiaries Age 65 to 74 |
120 |
Number Of Beneficiaries Age 75 to 84 |
163 |
Number Of Beneficiaries Age Greater 84 |
121 |
Number Of Female Beneficiaries |
203 |
Number Of Male Beneficiaries |
261 |
Number Of Non Hispanic White Beneficiaries |
452 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
384 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
80 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
33 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
30 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
36 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.4587 |