| National Provider Identifier [NPI]: | 1891714234 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1008 MINNEQUA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PUEBLO |
| Zip Code Of The Provider | 810043733 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 542 |
| Number Of Medicare Beneficiaries | 332 |
| Total Submitted Charge Amount | 176467 |
| Total Medicare Allowed Amount | 38283.93 |
| Total Medicare Payment Amount | 28994.89 |
| Total Medicare Standardized Payment Amount | 34386.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 38 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1789 |
| Total Drug Medicare AllowedAmount | 1142.07 |
| Total Drug Medicare PaymentAmount | 1112.93 |
| Total Drug Medicare Standardized Payment Amount | 1112.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 504 |
| Number Of Medicare Beneficiaries With Medical Services | 332 |
| Total Medical Submitted Charge Amount | 174678 |
| Total Medical Medicare Allowed Amount | 37141.86 |
| Total Medical Medicare Payment Amount | 27881.96 |
| Total Medical Medicare Standardized Payment Amount | 33273.34 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 147 |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 179 |
| Number Of Male Beneficiaries | 153 |
| Number Of Non Hispanic White Beneficiaries | 178 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 140 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 178 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 154 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.4403 |