| National Provider Identifier [NPI]: | 1417969346 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | GARY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 123 17TH |
| Street Address 2 Of The Provider | BRIGHAM BLDG./MAIL STOP 316 |
| City Of The Provider | RENO |
| Zip Code Of The Provider | 895570001 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 463 |
| Number Of Medicare Beneficiaries | 172 |
| Total Submitted Charge Amount | 74594 |
| Total Medicare Allowed Amount | 42801.25 |
| Total Medicare Payment Amount | 30445.07 |
| Total Medicare Standardized Payment Amount | 30577.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 282 |
| Total Drug Medicare AllowedAmount | 232.76 |
| Total Drug Medicare PaymentAmount | 226.11 |
| Total Drug Medicare Standardized Payment Amount | 226.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 443 |
| Number Of Medicare Beneficiaries With Medical Services | 172 |
| Total Medical Submitted Charge Amount | 74312 |
| Total Medical Medicare Allowed Amount | 42568.49 |
| Total Medical Medicare Payment Amount | 30218.96 |
| Total Medical Medicare Standardized Payment Amount | 30351.69 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 97 |
| Number Of Male Beneficiaries | 75 |
| Number Of Non Hispanic White Beneficiaries | 133 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 87 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4316 |