| National Provider Identifier [NPI]: | 1073565792 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | O |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 501 WASHINGTON ST |
| Street Address 2 Of The Provider | STE 510 |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921032231 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 213 |
| Number Of Services | 8880 |
| Number Of Medicare Beneficiaries | 2620 |
| Total Submitted Charge Amount | 2069512.59 |
| Total Medicare Allowed Amount | 513732.61 |
| Total Medicare Payment Amount | 393909.01 |
| Total Medicare Standardized Payment Amount | 387789.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 4280 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 8860 |
| Total Drug Medicare AllowedAmount | 835.78 |
| Total Drug Medicare PaymentAmount | 655.19 |
| Total Drug Medicare Standardized Payment Amount | 655.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 211 |
| Number Of Medical Services | 4600 |
| Number Of Medicare Beneficiaries With Medical Services | 2620 |
| Total Medical Submitted Charge Amount | 2060652.59 |
| Total Medical Medicare Allowed Amount | 512896.83 |
| Total Medical Medicare Payment Amount | 393253.82 |
| Total Medical Medicare Standardized Payment Amount | 387134.2 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 448 |
| Number Of Beneficiaries Age 65 to 74 | 1023 |
| Number Of Beneficiaries Age 75 to 84 | 720 |
| Number Of Beneficiaries Age Greater 84 | 429 |
| Number Of Female Beneficiaries | 1476 |
| Number Of Male Beneficiaries | 1144 |
| Number Of Non Hispanic White Beneficiaries | 1768 |
| Number Of Black or African American Beneficiaries | 233 |
| Number Of AsianPacific Islander Beneficiaries | 156 |
| Number Of Hispanic Beneficiaries | 404 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1572 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1048 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.8875 |