| National Provider Identifier [NPI]: | 1215229240 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | TRACY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 201 S 5TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BARDSTOWN |
| Zip Code Of The Provider | 400041142 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 1008 |
| Number Of Medicare Beneficiaries | 363 |
| Total Submitted Charge Amount | 63594 |
| Total Medicare Allowed Amount | 35417.55 |
| Total Medicare Payment Amount | 22491.57 |
| Total Medicare Standardized Payment Amount | 30086.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 309 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 4349 |
| Total Drug Medicare AllowedAmount | 861.92 |
| Total Drug Medicare PaymentAmount | 687.49 |
| Total Drug Medicare Standardized Payment Amount | 687.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 699 |
| Number Of Medicare Beneficiaries With Medical Services | 363 |
| Total Medical Submitted Charge Amount | 59245 |
| Total Medical Medicare Allowed Amount | 34555.63 |
| Total Medical Medicare Payment Amount | 21804.08 |
| Total Medical Medicare Standardized Payment Amount | 29399.07 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 116 |
| Number Of Beneficiaries Age 65 to 74 | 146 |
| Number Of Beneficiaries Age 75 to 84 | 75 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 237 |
| Number Of Male Beneficiaries | 126 |
| Number Of Non Hispanic White Beneficiaries | 347 |
| 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 | 238 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 125 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9851 |