National Provider Identifier [NPI]: |
1326030511 |
Last Name Of The Provider |
JOHNSON |
First Name Of The Provider |
YOLANDRA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
510 GREEN BAY RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
KENILWORTH |
Zip Code Of The Provider |
600431002 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Gastroenterology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
1053 |
Number Of Medicare Beneficiaries |
463 |
Total Submitted Charge Amount |
193333.15 |
Total Medicare Allowed Amount |
159680.39 |
Total Medicare Payment Amount |
120567.06 |
Total Medicare Standardized Payment Amount |
115786.37 |
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 |
28 |
Number Of Medical Services |
1053 |
Number Of Medicare Beneficiaries With Medical Services |
463 |
Total Medical Submitted Charge Amount |
193333.15 |
Total Medical Medicare Allowed Amount |
159680.39 |
Total Medical Medicare Payment Amount |
120567.06 |
Total Medical Medicare Standardized Payment Amount |
115786.37 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
16 |
Number Of Beneficiaries Age 65 to 74 |
286 |
Number Of Beneficiaries Age 75 to 84 |
134 |
Number Of Beneficiaries Age Greater 84 |
27 |
Number Of Female Beneficiaries |
336 |
Number Of Male Beneficiaries |
127 |
Number Of Non Hispanic White Beneficiaries |
399 |
Number Of Black or African American Beneficiaries |
33 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
17 |
Number Of Beneficiaries With Medicare Only Entitlement |
444 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
19 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
11 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
17 |
Percent Of With Hyperlipidemia |
45 |
Percent Of With Hypertension |
43 |
Percent Of With Ischemic Heart Disease |
19 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
2 |
Average HCC Risk Score Of Beneficiaries |
0.8946 |