| National Provider Identifier [NPI]: | 1174968085 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | TIFFANY |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3334 CAPITAL MEDICAL BLVD STE 400 |
| Street Address 2 Of The Provider | |
| City Of The Provider | TALLAHASSEE |
| Zip Code Of The Provider | 323084470 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 239 |
| Number Of Medicare Beneficiaries | 100 |
| Total Submitted Charge Amount | 47077 |
| Total Medicare Allowed Amount | 14155 |
| Total Medicare Payment Amount | 9899.76 |
| Total Medicare Standardized Payment Amount | 11566.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 372 |
| Total Drug Medicare AllowedAmount | 177.07 |
| Total Drug Medicare PaymentAmount | 126.18 |
| Total Drug Medicare Standardized Payment Amount | 126.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 208 |
| Number Of Medicare Beneficiaries With Medical Services | 100 |
| Total Medical Submitted Charge Amount | 46705 |
| Total Medical Medicare Allowed Amount | 13977.93 |
| Total Medical Medicare Payment Amount | 9773.58 |
| Total Medical Medicare Standardized Payment Amount | 11440.02 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 39 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 67 |
| Number Of Male Beneficiaries | 33 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 79 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1361 |