National Provider Identifier [NPI]: |
1326081316 |
Last Name Of The Provider |
JOHNSON |
First Name Of The Provider |
THERESE |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3267 S 16TH STREET |
Street Address 2 Of The Provider |
EMS OFFICE |
City Of The Provider |
MILWAUKEE |
Zip Code Of The Provider |
53215 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
24 |
Number Of Services |
282 |
Number Of Medicare Beneficiaries |
220 |
Total Submitted Charge Amount |
143337 |
Total Medicare Allowed Amount |
23330.3 |
Total Medicare Payment Amount |
16005.11 |
Total Medicare Standardized Payment Amount |
20270.91 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
24 |
Number Of Medical Services |
282 |
Number Of Medicare Beneficiaries With Medical Services |
220 |
Total Medical Submitted Charge Amount |
143337 |
Total Medical Medicare Allowed Amount |
23330.3 |
Total Medical Medicare Payment Amount |
16005.11 |
Total Medical Medicare Standardized Payment Amount |
20270.91 |
Average Age Of Beneficiaries |
59 |
Number Of Beneficiaries Age Less65 |
123 |
Number Of Beneficiaries Age 65 to 74 |
54 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
139 |
Number Of Male Beneficiaries |
81 |
Number Of Non Hispanic White Beneficiaries |
89 |
Number Of Black or African American Beneficiaries |
114 |
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 |
78 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
142 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
22 |
Percent Of With Cancer |
6 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
43 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
17 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.6875 |