| National Provider Identifier [NPI]: | 1790763837 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | JEFFREY |
| 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 | 3061 S MARYLAND PKWY |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891092298 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 169 |
| Number Of Services | 3532 |
| Number Of Medicare Beneficiaries | 2562 |
| Total Submitted Charge Amount | 378925 |
| Total Medicare Allowed Amount | 125507.44 |
| Total Medicare Payment Amount | 95805.09 |
| Total Medicare Standardized Payment Amount | 95022.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 169 |
| Number Of Medical Services | 3532 |
| Number Of Medicare Beneficiaries With Medical Services | 2562 |
| Total Medical Submitted Charge Amount | 378925 |
| Total Medical Medicare Allowed Amount | 125507.44 |
| Total Medical Medicare Payment Amount | 95805.09 |
| Total Medical Medicare Standardized Payment Amount | 95022.78 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 599 |
| Number Of Beneficiaries Age 65 to 74 | 879 |
| Number Of Beneficiaries Age 75 to 84 | 723 |
| Number Of Beneficiaries Age Greater 84 | 361 |
| Number Of Female Beneficiaries | 1420 |
| Number Of Male Beneficiaries | 1142 |
| Number Of Non Hispanic White Beneficiaries | 1719 |
| Number Of Black or African American Beneficiaries | 385 |
| Number Of AsianPacific Islander Beneficiaries | 133 |
| Number Of Hispanic Beneficiaries | 273 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1808 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 754 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 52 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.2492 |