National Provider Identifier [NPI]: |
1679507123 |
Last Name Of The Provider |
JOHNSTON |
First Name Of The Provider |
JOE |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8042 WURZBACH RD |
Street Address 2 Of The Provider |
STE 310 |
City Of The Provider |
SAN ANTONIO |
Zip Code Of The Provider |
782293818 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
65 |
Number Of Services |
453 |
Number Of Medicare Beneficiaries |
188 |
Total Submitted Charge Amount |
335408.25 |
Total Medicare Allowed Amount |
140385 |
Total Medicare Payment Amount |
105621.64 |
Total Medicare Standardized Payment Amount |
104241.01 |
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 |
65 |
Number Of Medical Services |
453 |
Number Of Medicare Beneficiaries With Medical Services |
188 |
Total Medical Submitted Charge Amount |
335408.25 |
Total Medical Medicare Allowed Amount |
140385 |
Total Medical Medicare Payment Amount |
105621.64 |
Total Medical Medicare Standardized Payment Amount |
104241.01 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
26 |
Number Of Beneficiaries Age 65 to 74 |
92 |
Number Of Beneficiaries Age 75 to 84 |
53 |
Number Of Beneficiaries Age Greater 84 |
17 |
Number Of Female Beneficiaries |
108 |
Number Of Male Beneficiaries |
80 |
Number Of Non Hispanic White Beneficiaries |
146 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
30 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
170 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
18 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
24 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
36 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
34 |
Percent Of With Hyperlipidemia |
70 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
46 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3961 |