| National Provider Identifier [NPI]: | 1225039118 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 202 W KANSAS AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ULYSSES |
| Zip Code Of The Provider | 678802034 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 81 |
| Number Of Services | 2107 |
| Number Of Medicare Beneficiaries | 328 |
| Total Submitted Charge Amount | 209482.5 |
| Total Medicare Allowed Amount | 88540.87 |
| Total Medicare Payment Amount | 62780.82 |
| Total Medicare Standardized Payment Amount | 68468.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 756 |
| Number Of Medicare Beneficiaries With Drug Services | 91 |
| Total Drug Submitted ChargeAmount | 8405 |
| Total Drug Medicare AllowedAmount | 2146.48 |
| Total Drug Medicare PaymentAmount | 1722.33 |
| Total Drug Medicare Standardized Payment Amount | 1722.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 1351 |
| Number Of Medicare Beneficiaries With Medical Services | 328 |
| Total Medical Submitted Charge Amount | 201077.5 |
| Total Medical Medicare Allowed Amount | 86394.39 |
| Total Medical Medicare Payment Amount | 61058.49 |
| Total Medical Medicare Standardized Payment Amount | 66745.98 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 118 |
| Number Of Beneficiaries Age 75 to 84 | 103 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 191 |
| Number Of Male Beneficiaries | 137 |
| Number Of Non Hispanic White Beneficiaries | 274 |
| 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 | 240 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 88 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0666 |