| National Provider Identifier [NPI]: | 1114971223 |
| Last Name Of The Provider | JOHNSTON |
| First Name Of The Provider | BRAD |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3707 NEW VISION DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468955602 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 171 |
| Number Of Services | 5225 |
| Number Of Medicare Beneficiaries | 2926 |
| Total Submitted Charge Amount | 514780.25 |
| Total Medicare Allowed Amount | 131231.89 |
| Total Medicare Payment Amount | 98289.87 |
| Total Medicare Standardized Payment Amount | 104978.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1214 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 12166.25 |
| Total Drug Medicare AllowedAmount | 825.33 |
| Total Drug Medicare PaymentAmount | 647.06 |
| Total Drug Medicare Standardized Payment Amount | 647.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 168 |
| Number Of Medical Services | 4011 |
| Number Of Medicare Beneficiaries With Medical Services | 2926 |
| Total Medical Submitted Charge Amount | 502614 |
| Total Medical Medicare Allowed Amount | 130406.56 |
| Total Medical Medicare Payment Amount | 97642.81 |
| Total Medical Medicare Standardized Payment Amount | 104331.66 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 692 |
| Number Of Beneficiaries Age 65 to 74 | 1036 |
| Number Of Beneficiaries Age 75 to 84 | 764 |
| Number Of Beneficiaries Age Greater 84 | 434 |
| Number Of Female Beneficiaries | 1792 |
| Number Of Male Beneficiaries | 1134 |
| Number Of Non Hispanic White Beneficiaries | 2755 |
| Number Of Black or African American Beneficiaries | 96 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2089 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 837 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4732 |