| National Provider Identifier [NPI]: | 1336328624 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1661 HWY 99 N STE 201 |
| Street Address 2 Of The Provider | |
| City Of The Provider | ASHLAND |
| Zip Code Of The Provider | 975208900 |
| State Code Of The Provider | OR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 1291 |
| Number Of Medicare Beneficiaries | 347 |
| Total Submitted Charge Amount | 241065.33 |
| Total Medicare Allowed Amount | 96824.09 |
| Total Medicare Payment Amount | 69718.95 |
| Total Medicare Standardized Payment Amount | 72611.05 |
| 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 | 53 |
| Number Of Medical Services | 1291 |
| Number Of Medicare Beneficiaries With Medical Services | 347 |
| Total Medical Submitted Charge Amount | 241065.33 |
| Total Medical Medicare Allowed Amount | 96824.09 |
| Total Medical Medicare Payment Amount | 69718.95 |
| Total Medical Medicare Standardized Payment Amount | 72611.05 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 150 |
| Number Of Beneficiaries Age 75 to 84 | 87 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | 192 |
| Number Of Male Beneficiaries | 155 |
| Number Of Non Hispanic White Beneficiaries | 329 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 290 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0334 |