| National Provider Identifier [NPI]: | 1811908445 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | SHAWN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5001 US HIGHWAY 30 W STE D |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468189701 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 5827 |
| Number Of Medicare Beneficiaries | 4427 |
| Total Submitted Charge Amount | 656983.5 |
| Total Medicare Allowed Amount | 176628.22 |
| Total Medicare Payment Amount | 136789.54 |
| Total Medicare Standardized Payment Amount | 143515.1 |
| 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 | 167 |
| Number Of Medical Services | 5827 |
| Number Of Medicare Beneficiaries With Medical Services | 4427 |
| Total Medical Submitted Charge Amount | 656983.5 |
| Total Medical Medicare Allowed Amount | 176628.22 |
| Total Medical Medicare Payment Amount | 136789.54 |
| Total Medical Medicare Standardized Payment Amount | 143515.1 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 858 |
| Number Of Beneficiaries Age 65 to 74 | 1660 |
| Number Of Beneficiaries Age 75 to 84 | 1209 |
| Number Of Beneficiaries Age Greater 84 | 700 |
| Number Of Female Beneficiaries | 2941 |
| Number Of Male Beneficiaries | 1486 |
| Number Of Non Hispanic White Beneficiaries | 4072 |
| Number Of Black or African American Beneficiaries | 217 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 58 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 55 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3232 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1195 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5604 |