National Provider Identifier [NPI]: |
1942401286 |
Last Name Of The Provider |
JOHNSON |
First Name Of The Provider |
TIMOTHY |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
222 15TH AVE SE |
Street Address 2 Of The Provider |
|
City Of The Provider |
PUYALLUP |
Zip Code Of The Provider |
983723754 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
146 |
Number Of Services |
29573 |
Number Of Medicare Beneficiaries |
2386 |
Total Submitted Charge Amount |
904159 |
Total Medicare Allowed Amount |
250618.84 |
Total Medicare Payment Amount |
190997.13 |
Total Medicare Standardized Payment Amount |
192654.41 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
26228 |
Number Of Medicare Beneficiaries With Drug Services |
294 |
Total Drug Submitted ChargeAmount |
52678 |
Total Drug Medicare AllowedAmount |
5727.49 |
Total Drug Medicare PaymentAmount |
4436.21 |
Total Drug Medicare Standardized Payment Amount |
4436.21 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
142 |
Number Of Medical Services |
3345 |
Number Of Medicare Beneficiaries With Medical Services |
2386 |
Total Medical Submitted Charge Amount |
851481 |
Total Medical Medicare Allowed Amount |
244891.35 |
Total Medical Medicare Payment Amount |
186560.92 |
Total Medical Medicare Standardized Payment Amount |
188218.2 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
307 |
Number Of Beneficiaries Age 65 to 74 |
901 |
Number Of Beneficiaries Age 75 to 84 |
786 |
Number Of Beneficiaries Age Greater 84 |
392 |
Number Of Female Beneficiaries |
1431 |
Number Of Male Beneficiaries |
955 |
Number Of Non Hispanic White Beneficiaries |
2144 |
Number Of Black or African American Beneficiaries |
66 |
Number Of AsianPacific Islander Beneficiaries |
58 |
Number Of Hispanic Beneficiaries |
54 |
Number Of American Indian Alaska Native Beneficiaries |
25 |
Number Of Beneficiaries With Race Not Else where Classified |
39 |
Number Of Beneficiaries With Medicare Only Entitlement |
1959 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
427 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
29 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
38 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.6159 |