| National Provider Identifier [NPI]: | 1588628739 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 621 N HALL ST |
| Street Address 2 Of The Provider | SUITE 500 |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752261339 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 2140 |
| Number Of Medicare Beneficiaries | 383 |
| Total Submitted Charge Amount | 581049.7 |
| Total Medicare Allowed Amount | 258798.24 |
| Total Medicare Payment Amount | 197394.17 |
| Total Medicare Standardized Payment Amount | 198466.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 364 |
| Number Of Medicare Beneficiaries With Drug Services | 88 |
| Total Drug Submitted ChargeAmount | 43355 |
| Total Drug Medicare AllowedAmount | 18281.72 |
| Total Drug Medicare PaymentAmount | 14332.71 |
| Total Drug Medicare Standardized Payment Amount | 14332.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 1776 |
| Number Of Medicare Beneficiaries With Medical Services | 383 |
| Total Medical Submitted Charge Amount | 537694.7 |
| Total Medical Medicare Allowed Amount | 240516.52 |
| Total Medical Medicare Payment Amount | 183061.46 |
| Total Medical Medicare Standardized Payment Amount | 184133.75 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 163 |
| Number Of Beneficiaries Age 75 to 84 | 130 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 205 |
| Number Of Male Beneficiaries | 178 |
| Number Of Non Hispanic White Beneficiaries | 296 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 326 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5052 |