| National Provider Identifier [NPI]: | 1265533533 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | GERALD |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 410 NEW ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MANNING |
| Zip Code Of The Provider | 291023311 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 136 |
| Number Of Services | 14179 |
| Number Of Medicare Beneficiaries | 810 |
| Total Submitted Charge Amount | 591888.68 |
| Total Medicare Allowed Amount | 235040.44 |
| Total Medicare Payment Amount | 171031.83 |
| Total Medicare Standardized Payment Amount | 191512.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 20 |
| Number Of Drug Services | 7806 |
| Number Of Medicare Beneficiaries With Drug Services | 598 |
| Total Drug Submitted ChargeAmount | 64914.87 |
| Total Drug Medicare AllowedAmount | 3276.23 |
| Total Drug Medicare PaymentAmount | 2356.48 |
| Total Drug Medicare Standardized Payment Amount | 2356.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 116 |
| Number Of Medical Services | 6373 |
| Number Of Medicare Beneficiaries With Medical Services | 810 |
| Total Medical Submitted Charge Amount | 526973.81 |
| Total Medical Medicare Allowed Amount | 231764.21 |
| Total Medical Medicare Payment Amount | 168675.35 |
| Total Medical Medicare Standardized Payment Amount | 189156.45 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 92 |
| Number Of Beneficiaries Age 65 to 74 | 420 |
| Number Of Beneficiaries Age 75 to 84 | 238 |
| Number Of Beneficiaries Age Greater 84 | 60 |
| Number Of Female Beneficiaries | 452 |
| Number Of Male Beneficiaries | 358 |
| Number Of Non Hispanic White Beneficiaries | 640 |
| 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 | 752 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 58 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0171 |