| National Provider Identifier [NPI]: | 1447234307 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 201 S 14TH ST |
| Street Address 2 Of The Provider | PATHOLOGY DEPARTMENT |
| City Of The Provider | HERRIN |
| Zip Code Of The Provider | 629483631 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 4240 |
| Number Of Medicare Beneficiaries | 1464 |
| Total Submitted Charge Amount | 643554 |
| Total Medicare Allowed Amount | 151902.44 |
| Total Medicare Payment Amount | 113349.91 |
| Total Medicare Standardized Payment Amount | 78772.47 |
| 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 | 20 |
| Number Of Medical Services | 4240 |
| Number Of Medicare Beneficiaries With Medical Services | 1464 |
| Total Medical Submitted Charge Amount | 643554 |
| Total Medical Medicare Allowed Amount | 151902.44 |
| Total Medical Medicare Payment Amount | 113349.91 |
| Total Medical Medicare Standardized Payment Amount | 78772.47 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 371 |
| Number Of Beneficiaries Age 65 to 74 | 578 |
| Number Of Beneficiaries Age 75 to 84 | 373 |
| Number Of Beneficiaries Age Greater 84 | 142 |
| Number Of Female Beneficiaries | 856 |
| Number Of Male Beneficiaries | 608 |
| Number Of Non Hispanic White Beneficiaries | 1418 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 977 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 487 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5716 |