| National Provider Identifier [NPI]: | 1356484596 |
| Last Name Of The Provider | JOHNSTON |
| First Name Of The Provider | NICKLETT |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | NP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3201 E PRESIDENT GEORGE BUSH HWY STE 107 |
| Street Address 2 Of The Provider | |
| City Of The Provider | RICHARDSON |
| Zip Code Of The Provider | 750823565 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 540 |
| Number Of Medicare Beneficiaries | 98 |
| Total Submitted Charge Amount | 29689 |
| Total Medicare Allowed Amount | 17990.39 |
| Total Medicare Payment Amount | 10459.65 |
| Total Medicare Standardized Payment Amount | 13833.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 180 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 1025 |
| Total Drug Medicare AllowedAmount | 417.44 |
| Total Drug Medicare PaymentAmount | 387.3 |
| Total Drug Medicare Standardized Payment Amount | 387.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 360 |
| Number Of Medicare Beneficiaries With Medical Services | 98 |
| Total Medical Submitted Charge Amount | 28664 |
| Total Medical Medicare Allowed Amount | 17572.95 |
| Total Medical Medicare Payment Amount | 10072.35 |
| Total Medical Medicare Standardized Payment Amount | 13445.89 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 49 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 59 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | 55 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 67 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 19 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8722 |