| National Provider Identifier [NPI]: | 1245236215 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 30550 UTICA RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROSEVILLE |
| Zip Code Of The Provider | 480661528 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 126 |
| Number Of Services | 15854 |
| Number Of Medicare Beneficiaries | 1778 |
| Total Submitted Charge Amount | 2141525 |
| Total Medicare Allowed Amount | 1213259.31 |
| Total Medicare Payment Amount | 922921.72 |
| Total Medicare Standardized Payment Amount | 897648.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 145 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 2660 |
| Total Drug Medicare AllowedAmount | 719.23 |
| Total Drug Medicare PaymentAmount | 588.64 |
| Total Drug Medicare Standardized Payment Amount | 588.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 114 |
| Number Of Medical Services | 15709 |
| Number Of Medicare Beneficiaries With Medical Services | 1778 |
| Total Medical Submitted Charge Amount | 2138865 |
| Total Medical Medicare Allowed Amount | 1212540.08 |
| Total Medical Medicare Payment Amount | 922333.08 |
| Total Medical Medicare Standardized Payment Amount | 897059.61 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 328 |
| Number Of Beneficiaries Age 65 to 74 | 423 |
| Number Of Beneficiaries Age 75 to 84 | 446 |
| Number Of Beneficiaries Age Greater 84 | 581 |
| Number Of Female Beneficiaries | 1129 |
| Number Of Male Beneficiaries | 649 |
| Number Of Non Hispanic White Beneficiaries | 1474 |
| Number Of Black or African American Beneficiaries | 266 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1062 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 716 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 51 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.1697 |