| National Provider Identifier [NPI]: | 1265584312 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 585 W CHERRY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORTH LIBERTY |
| Zip Code Of The Provider | 523179797 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 672 |
| Number Of Medicare Beneficiaries | 133 |
| Total Submitted Charge Amount | 45100.5 |
| Total Medicare Allowed Amount | 25917.7 |
| Total Medicare Payment Amount | 18238.72 |
| Total Medicare Standardized Payment Amount | 19672.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 66 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 4931 |
| Total Drug Medicare AllowedAmount | 3561.21 |
| Total Drug Medicare PaymentAmount | 3315.67 |
| Total Drug Medicare Standardized Payment Amount | 3315.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 606 |
| Number Of Medicare Beneficiaries With Medical Services | 133 |
| Total Medical Submitted Charge Amount | 40169.5 |
| Total Medical Medicare Allowed Amount | 22356.49 |
| Total Medical Medicare Payment Amount | 14923.05 |
| Total Medical Medicare Standardized Payment Amount | 16356.48 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 85 |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 90 |
| Number Of Male Beneficiaries | 43 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 37 |
| Percent Of With Ischemic Heart Disease | 12 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 18 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.6693 |