| National Provider Identifier [NPI]: | 1336129667 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 830 AINSWORTH DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PRESCOTT |
| Zip Code Of The Provider | 863011614 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 9052 |
| Number Of Medicare Beneficiaries | 1650 |
| Total Submitted Charge Amount | 876914 |
| Total Medicare Allowed Amount | 524548.48 |
| Total Medicare Payment Amount | 374967.18 |
| Total Medicare Standardized Payment Amount | 379317.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 54 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 540 |
| Total Drug Medicare AllowedAmount | 98.66 |
| Total Drug Medicare PaymentAmount | 77.33 |
| Total Drug Medicare Standardized Payment Amount | 77.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 81 |
| Number Of Medical Services | 8998 |
| Number Of Medicare Beneficiaries With Medical Services | 1650 |
| Total Medical Submitted Charge Amount | 876374 |
| Total Medical Medicare Allowed Amount | 524449.82 |
| Total Medical Medicare Payment Amount | 374889.85 |
| Total Medical Medicare Standardized Payment Amount | 379240.5 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | 869 |
| Number Of Beneficiaries Age 75 to 84 | 518 |
| Number Of Beneficiaries Age Greater 84 | 198 |
| Number Of Female Beneficiaries | 830 |
| Number Of Male Beneficiaries | 820 |
| Number Of Non Hispanic White Beneficiaries | 1599 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1587 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 63 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8691 |