| National Provider Identifier [NPI]: | 1447205554 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2905 BOULEVARD |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLONIAL HEIGHTS |
| Zip Code Of The Provider | 238342400 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 3104 |
| Number Of Medicare Beneficiaries | 658 |
| Total Submitted Charge Amount | 487843 |
| Total Medicare Allowed Amount | 255073.6 |
| Total Medicare Payment Amount | 188702.82 |
| Total Medicare Standardized Payment Amount | 195340.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 480 |
| Total Drug Medicare AllowedAmount | 338.4 |
| Total Drug Medicare PaymentAmount | 331.68 |
| Total Drug Medicare Standardized Payment Amount | 331.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 3080 |
| Number Of Medicare Beneficiaries With Medical Services | 650 |
| Total Medical Submitted Charge Amount | 487363 |
| Total Medical Medicare Allowed Amount | 254735.2 |
| Total Medical Medicare Payment Amount | 188371.14 |
| Total Medical Medicare Standardized Payment Amount | 195009.24 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 103 |
| Number Of Beneficiaries Age 65 to 74 | 240 |
| Number Of Beneficiaries Age 75 to 84 | 179 |
| Number Of Beneficiaries Age Greater 84 | 136 |
| Number Of Female Beneficiaries | 409 |
| Number Of Male Beneficiaries | 249 |
| Number Of Non Hispanic White Beneficiaries | 339 |
| Number Of Black or African American Beneficiaries | 302 |
| 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 | 479 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 179 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 52 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.0095 |