National Provider Identifier [NPI]: |
1083693444 |
Last Name Of The Provider |
JOHNSTON |
First Name Of The Provider |
MARIA |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
FNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3939 S PARK AVE |
Street Address 2 Of The Provider |
#150 |
City Of The Provider |
TUCSON |
Zip Code Of The Provider |
857141635 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
22 |
Number Of Services |
248 |
Number Of Medicare Beneficiaries |
105 |
Total Submitted Charge Amount |
41843.5 |
Total Medicare Allowed Amount |
15079.83 |
Total Medicare Payment Amount |
10971.62 |
Total Medicare Standardized Payment Amount |
13095.97 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
23 |
Number Of Medicare Beneficiaries With Drug Services |
11 |
Total Drug Submitted ChargeAmount |
630.5 |
Total Drug Medicare AllowedAmount |
395.71 |
Total Drug Medicare PaymentAmount |
383.17 |
Total Drug Medicare Standardized Payment Amount |
383.17 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
19 |
Number Of Medical Services |
225 |
Number Of Medicare Beneficiaries With Medical Services |
105 |
Total Medical Submitted Charge Amount |
41213 |
Total Medical Medicare Allowed Amount |
14684.12 |
Total Medical Medicare Payment Amount |
10588.45 |
Total Medical Medicare Standardized Payment Amount |
12712.8 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
11 |
Number Of Beneficiaries Age 65 to 74 |
49 |
Number Of Beneficiaries Age 75 to 84 |
28 |
Number Of Beneficiaries Age Greater 84 |
17 |
Number Of Female Beneficiaries |
80 |
Number Of Male Beneficiaries |
25 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
59 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
71 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
34 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
11 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1579 |