| National Provider Identifier [NPI]: | 1477597094 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | REBECCA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1205 PROVIDENT DRIVE |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | WARSAW |
| Zip Code Of The Provider | 465803265 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 2266 |
| Number Of Medicare Beneficiaries | 485 |
| Total Submitted Charge Amount | 253211 |
| Total Medicare Allowed Amount | 125352.41 |
| Total Medicare Payment Amount | 82874.66 |
| Total Medicare Standardized Payment Amount | 89643.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 200 |
| Number Of Medicare Beneficiaries With Drug Services | 118 |
| Total Drug Submitted ChargeAmount | 9010 |
| Total Drug Medicare AllowedAmount | 3723.14 |
| Total Drug Medicare PaymentAmount | 3445.52 |
| Total Drug Medicare Standardized Payment Amount | 3445.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 2066 |
| Number Of Medicare Beneficiaries With Medical Services | 485 |
| Total Medical Submitted Charge Amount | 244201 |
| Total Medical Medicare Allowed Amount | 121629.27 |
| Total Medical Medicare Payment Amount | 79429.14 |
| Total Medical Medicare Standardized Payment Amount | 86197.61 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 73 |
| Number Of Beneficiaries Age 65 to 74 | 141 |
| Number Of Beneficiaries Age 75 to 84 | 138 |
| Number Of Beneficiaries Age Greater 84 | 133 |
| Number Of Female Beneficiaries | 321 |
| Number Of Male Beneficiaries | 164 |
| Number Of Non Hispanic White Beneficiaries | 472 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 373 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 112 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4798 |