| National Provider Identifier [NPI]: | 1194953695 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | SUZANNE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11203 77TH ST E |
| Street Address 2 Of The Provider | |
| City Of The Provider | PARRISH |
| Zip Code Of The Provider | 342192755 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 297 |
| Number Of Medicare Beneficiaries | 140 |
| Total Submitted Charge Amount | 47128 |
| Total Medicare Allowed Amount | 21264.99 |
| Total Medicare Payment Amount | 13123.96 |
| Total Medicare Standardized Payment Amount | 13736.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 14 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 821 |
| Total Drug Medicare AllowedAmount | 306.16 |
| Total Drug Medicare PaymentAmount | 296.73 |
| Total Drug Medicare Standardized Payment Amount | 296.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 283 |
| Number Of Medicare Beneficiaries With Medical Services | 140 |
| Total Medical Submitted Charge Amount | 46307 |
| Total Medical Medicare Allowed Amount | 20958.83 |
| Total Medical Medicare Payment Amount | 12827.23 |
| Total Medical Medicare Standardized Payment Amount | 13440.04 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 79 |
| Number Of Male Beneficiaries | 61 |
| 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 | 91 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0811 |