| National Provider Identifier [NPI]: | 1134168925 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | WARREN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D., PH.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11209 N TATUM BLVD |
| Street Address 2 Of The Provider | SUITE 180 |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850283091 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 1603 |
| Number Of Medicare Beneficiaries | 556 |
| Total Submitted Charge Amount | 183712 |
| Total Medicare Allowed Amount | 124347.63 |
| Total Medicare Payment Amount | 89462.98 |
| Total Medicare Standardized Payment Amount | 91235.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 146 |
| Number Of Medicare Beneficiaries With Drug Services | 110 |
| Total Drug Submitted ChargeAmount | 5796 |
| Total Drug Medicare AllowedAmount | 4458.87 |
| Total Drug Medicare PaymentAmount | 4326.58 |
| Total Drug Medicare Standardized Payment Amount | 4326.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 1457 |
| Number Of Medicare Beneficiaries With Medical Services | 555 |
| Total Medical Submitted Charge Amount | 177916 |
| Total Medical Medicare Allowed Amount | 119888.76 |
| Total Medical Medicare Payment Amount | 85136.4 |
| Total Medical Medicare Standardized Payment Amount | 86908.8 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 330 |
| Number Of Beneficiaries Age 75 to 84 | 144 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 311 |
| Number Of Male Beneficiaries | 245 |
| Number Of Non Hispanic White Beneficiaries | 512 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 523 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 42 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8349 |