National Provider Identifier [NPI]: |
1912905464 |
Last Name Of The Provider |
JOHNSON |
First Name Of The Provider |
MAE |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
FNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1107 MEMORIAL DR |
Street Address 2 Of The Provider |
SUITE 300 |
City Of The Provider |
DALTON |
Zip Code Of The Provider |
307208662 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
77 |
Number Of Services |
7993 |
Number Of Medicare Beneficiaries |
461 |
Total Submitted Charge Amount |
303742 |
Total Medicare Allowed Amount |
151035.51 |
Total Medicare Payment Amount |
109347.99 |
Total Medicare Standardized Payment Amount |
129183.41 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
13 |
Number Of Drug Services |
2924 |
Number Of Medicare Beneficiaries With Drug Services |
186 |
Total Drug Submitted ChargeAmount |
65238 |
Total Drug Medicare AllowedAmount |
23857.27 |
Total Drug Medicare PaymentAmount |
17743.73 |
Total Drug Medicare Standardized Payment Amount |
17743.73 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
64 |
Number Of Medical Services |
5069 |
Number Of Medicare Beneficiaries With Medical Services |
461 |
Total Medical Submitted Charge Amount |
238504 |
Total Medical Medicare Allowed Amount |
127178.24 |
Total Medical Medicare Payment Amount |
91604.26 |
Total Medical Medicare Standardized Payment Amount |
111439.68 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
23 |
Number Of Beneficiaries Age 65 to 74 |
190 |
Number Of Beneficiaries Age 75 to 84 |
177 |
Number Of Beneficiaries Age Greater 84 |
71 |
Number Of Female Beneficiaries |
355 |
Number Of Male Beneficiaries |
106 |
Number Of Non Hispanic White Beneficiaries |
450 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
411 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
50 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
3 |
Percent Of With Cancer |
6 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
8 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
8 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
26 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
0.8347 |