| National Provider Identifier [NPI]: | 1609812932 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | DAWN |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 HITCHCOCK WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | MANCHESTER |
| Zip Code Of The Provider | 031044125 |
| State Code Of The Provider | NH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 29 |
| Number Of Services | 574 |
| Number Of Medicare Beneficiaries | 284 |
| Total Submitted Charge Amount | 74922.28 |
| Total Medicare Allowed Amount | 24447.04 |
| Total Medicare Payment Amount | 16737.98 |
| Total Medicare Standardized Payment Amount | 20176.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 136 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 1324.56 |
| Total Drug Medicare AllowedAmount | 229.6 |
| Total Drug Medicare PaymentAmount | 185.97 |
| Total Drug Medicare Standardized Payment Amount | 185.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 438 |
| Number Of Medicare Beneficiaries With Medical Services | 284 |
| Total Medical Submitted Charge Amount | 73597.72 |
| Total Medical Medicare Allowed Amount | 24217.44 |
| Total Medical Medicare Payment Amount | 16552.01 |
| Total Medical Medicare Standardized Payment Amount | 19990.32 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 113 |
| Number Of Beneficiaries Age 65 to 74 | 101 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 181 |
| Number Of Male Beneficiaries | 103 |
| Number Of Non Hispanic White Beneficiaries | 262 |
| Number Of Black or African American Beneficiaries | |
| 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 | 201 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9851 |