| National Provider Identifier [NPI]: | 1538150610 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | DIANNE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3599 UNIVERSITY BLVD. S. |
| Street Address 2 Of The Provider | BLDG. 300 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322160000 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 122 |
| Number Of Services | 5561 |
| Number Of Medicare Beneficiaries | 3154 |
| Total Submitted Charge Amount | 426804 |
| Total Medicare Allowed Amount | 112481.17 |
| Total Medicare Payment Amount | 93057.8 |
| Total Medicare Standardized Payment Amount | 92808.89 |
| 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 | 122 |
| Number Of Medical Services | 5561 |
| Number Of Medicare Beneficiaries With Medical Services | 3154 |
| Total Medical Submitted Charge Amount | 426804 |
| Total Medical Medicare Allowed Amount | 112481.17 |
| Total Medical Medicare Payment Amount | 93057.8 |
| Total Medical Medicare Standardized Payment Amount | 92808.89 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 377 |
| Number Of Beneficiaries Age 65 to 74 | 1516 |
| Number Of Beneficiaries Age 75 to 84 | 888 |
| Number Of Beneficiaries Age Greater 84 | 373 |
| Number Of Female Beneficiaries | 2373 |
| Number Of Male Beneficiaries | 781 |
| Number Of Non Hispanic White Beneficiaries | 2548 |
| Number Of Black or African American Beneficiaries | 435 |
| Number Of AsianPacific Islander Beneficiaries | 51 |
| Number Of Hispanic Beneficiaries | 79 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2616 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 538 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6991 |