| 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 |