| National Provider Identifier [NPI]: | 1063527711 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 769 MEDICAL CENTER CT |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | CHULA VISTA |
| Zip Code Of The Provider | 919116660 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 157140 |
| Number Of Medicare Beneficiaries | 503 |
| Total Submitted Charge Amount | 3395515 |
| Total Medicare Allowed Amount | 1625870.34 |
| Total Medicare Payment Amount | 1261275.93 |
| Total Medicare Standardized Payment Amount | 1248766.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 43 |
| Number Of Drug Services | 150632 |
| Number Of Medicare Beneficiaries With Drug Services | 132 |
| Total Drug Submitted ChargeAmount | 2913349 |
| Total Drug Medicare AllowedAmount | 1287560.05 |
| Total Drug Medicare PaymentAmount | 1007508.79 |
| Total Drug Medicare Standardized Payment Amount | 1007508.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 6508 |
| Number Of Medicare Beneficiaries With Medical Services | 503 |
| Total Medical Submitted Charge Amount | 482166 |
| Total Medical Medicare Allowed Amount | 338310.29 |
| Total Medical Medicare Payment Amount | 253767.14 |
| Total Medical Medicare Standardized Payment Amount | 241257.3 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 166 |
| Number Of Beneficiaries Age 75 to 84 | 159 |
| Number Of Beneficiaries Age Greater 84 | 104 |
| Number Of Female Beneficiaries | 277 |
| Number Of Male Beneficiaries | 226 |
| Number Of Non Hispanic White Beneficiaries | 180 |
| Number Of Black or African American Beneficiaries | 56 |
| Number Of AsianPacific Islander Beneficiaries | 75 |
| Number Of Hispanic Beneficiaries | 167 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 233 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 270 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 40 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.3487 |