| National Provider Identifier [NPI]: | 1689609125 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 311 W ROSEWOOD AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782122219 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 15186 |
| Number Of Medicare Beneficiaries | 1094 |
| Total Submitted Charge Amount | 1483880 |
| Total Medicare Allowed Amount | 806174.63 |
| Total Medicare Payment Amount | 614891.98 |
| Total Medicare Standardized Payment Amount | 646784.51 |
| 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 | 16 |
| Number Of Medical Services | 15186 |
| Number Of Medicare Beneficiaries With Medical Services | 1094 |
| Total Medical Submitted Charge Amount | 1483880 |
| Total Medical Medicare Allowed Amount | 806174.63 |
| Total Medical Medicare Payment Amount | 614891.98 |
| Total Medical Medicare Standardized Payment Amount | 646784.51 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 413 |
| Number Of Beneficiaries Age 65 to 74 | 249 |
| Number Of Beneficiaries Age 75 to 84 | 229 |
| Number Of Beneficiaries Age Greater 84 | 203 |
| Number Of Female Beneficiaries | 580 |
| Number Of Male Beneficiaries | 514 |
| Number Of Non Hispanic White Beneficiaries | 495 |
| Number Of Black or African American Beneficiaries | 158 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 427 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 186 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 908 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 63 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 3 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 65 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.2237 |