| National Provider Identifier [NPI]: | 1114015351 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | LAWRENCE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 351 DELNOR DR |
| Street Address 2 Of The Provider | STE 400 |
| City Of The Provider | GENEVA |
| Zip Code Of The Provider | 601344209 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 5471 |
| Number Of Medicare Beneficiaries | 1300 |
| Total Submitted Charge Amount | 595561.71 |
| Total Medicare Allowed Amount | 395931.46 |
| Total Medicare Payment Amount | 285174.63 |
| Total Medicare Standardized Payment Amount | 266622.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 9600 |
| Total Drug Medicare AllowedAmount | 8049.1 |
| Total Drug Medicare PaymentAmount | 6195.14 |
| Total Drug Medicare Standardized Payment Amount | 6195.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 75 |
| Number Of Medical Services | 5437 |
| Number Of Medicare Beneficiaries With Medical Services | 1299 |
| Total Medical Submitted Charge Amount | 585961.71 |
| Total Medical Medicare Allowed Amount | 387882.36 |
| Total Medical Medicare Payment Amount | 278979.49 |
| Total Medical Medicare Standardized Payment Amount | 260427.75 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 591 |
| Number Of Beneficiaries Age 75 to 84 | 475 |
| Number Of Beneficiaries Age Greater 84 | 208 |
| Number Of Female Beneficiaries | 633 |
| Number Of Male Beneficiaries | 667 |
| Number Of Non Hispanic White Beneficiaries | 1263 |
| 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 | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1274 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9127 |