| National Provider Identifier [NPI]: | 1376697466 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | A.P.N. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1640 N ARLINGTON HEIGHTS RD |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | ARLINGTON HEIGHTS |
| Zip Code Of The Provider | 600043985 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 345 |
| Number Of Medicare Beneficiaries | 145 |
| Total Submitted Charge Amount | 12575.63 |
| Total Medicare Allowed Amount | 10320.01 |
| Total Medicare Payment Amount | 7567.17 |
| Total Medicare Standardized Payment Amount | 8875.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 190 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 4154.73 |
| Total Drug Medicare AllowedAmount | 3655.5 |
| Total Drug Medicare PaymentAmount | 3244.4 |
| Total Drug Medicare Standardized Payment Amount | 3244.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 155 |
| Number Of Medicare Beneficiaries With Medical Services | 145 |
| Total Medical Submitted Charge Amount | 8420.9 |
| Total Medical Medicare Allowed Amount | 6664.51 |
| Total Medical Medicare Payment Amount | 4322.77 |
| Total Medical Medicare Standardized Payment Amount | 5630.76 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | 81 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 93 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 130 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9067 |