| National Provider Identifier [NPI]: | 1982799011 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1625 RAMBLEWOOD DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAST LANSING |
| Zip Code Of The Provider | 488236367 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 89 |
| Number Of Services | 2891 |
| Number Of Medicare Beneficiaries | 571 |
| Total Submitted Charge Amount | 674940 |
| Total Medicare Allowed Amount | 240170.2 |
| Total Medicare Payment Amount | 181683.83 |
| Total Medicare Standardized Payment Amount | 188378.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 296 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 73790 |
| Total Drug Medicare AllowedAmount | 57221.99 |
| Total Drug Medicare PaymentAmount | 44660.71 |
| Total Drug Medicare Standardized Payment Amount | 44660.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 85 |
| Number Of Medical Services | 2595 |
| Number Of Medicare Beneficiaries With Medical Services | 571 |
| Total Medical Submitted Charge Amount | 601150 |
| Total Medical Medicare Allowed Amount | 182948.21 |
| Total Medical Medicare Payment Amount | 137023.12 |
| Total Medical Medicare Standardized Payment Amount | 143717.65 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 203 |
| Number Of Beneficiaries Age 75 to 84 | 210 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 123 |
| Number Of Male Beneficiaries | 448 |
| Number Of Non Hispanic White Beneficiaries | 507 |
| Number Of Black or African American Beneficiaries | 36 |
| 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 | 495 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4764 |