| National Provider Identifier [NPI]: | 1447221031 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9040 FITZSIMMONS DR |
| Street Address 2 Of The Provider | MADIGAN ARMY MEDICAL CENTER |
| City Of The Provider | JOINT BASE LEWIS MCCHORD |
| Zip Code Of The Provider | 984311000 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 245 |
| Number Of Medicare Beneficiaries | 165 |
| Total Submitted Charge Amount | 196172 |
| Total Medicare Allowed Amount | 26564.23 |
| Total Medicare Payment Amount | 19363.71 |
| Total Medicare Standardized Payment Amount | 19844.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 245 |
| Number Of Medicare Beneficiaries With Medical Services | 165 |
| Total Medical Submitted Charge Amount | 196172 |
| Total Medical Medicare Allowed Amount | 26564.23 |
| Total Medical Medicare Payment Amount | 19363.71 |
| Total Medical Medicare Standardized Payment Amount | 19844.19 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 34 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 81 |
| Number Of Male Beneficiaries | 84 |
| Number Of Non Hispanic White Beneficiaries | 80 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 64 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 56 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 21 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.65 |