| National Provider Identifier [NPI]: | 1386699502 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | KENT |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14541 W INDIAN SCHOOL ROAD |
| Street Address 2 Of The Provider | STE 600 |
| City Of The Provider | GOODYEAR |
| Zip Code Of The Provider | 85395 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 4547 |
| Number Of Medicare Beneficiaries | 1027 |
| Total Submitted Charge Amount | 554297 |
| Total Medicare Allowed Amount | 351834.28 |
| Total Medicare Payment Amount | 254138.3 |
| Total Medicare Standardized Payment Amount | 258023.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 357 |
| Number Of Medicare Beneficiaries With Drug Services | 282 |
| Total Drug Submitted ChargeAmount | 15877 |
| Total Drug Medicare AllowedAmount | 10074.08 |
| Total Drug Medicare PaymentAmount | 9838.05 |
| Total Drug Medicare Standardized Payment Amount | 9838.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 4190 |
| Number Of Medicare Beneficiaries With Medical Services | 1027 |
| Total Medical Submitted Charge Amount | 538420 |
| Total Medical Medicare Allowed Amount | 341760.2 |
| Total Medical Medicare Payment Amount | 244300.25 |
| Total Medical Medicare Standardized Payment Amount | 248185.72 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 639 |
| Number Of Beneficiaries Age 75 to 84 | 295 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 523 |
| Number Of Male Beneficiaries | 504 |
| Number Of Non Hispanic White Beneficiaries | 952 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1015 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9216 |