| National Provider Identifier [NPI]: | 1609812718 |
| Last Name Of The Provider | JOHANNSEN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 450 E 23RD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FREMONT |
| Zip Code Of The Provider | 68025 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 161 |
| Number Of Services | 5329 |
| Number Of Medicare Beneficiaries | 2464 |
| Total Submitted Charge Amount | 185985.5 |
| Total Medicare Allowed Amount | 164304.54 |
| Total Medicare Payment Amount | 124602.8 |
| Total Medicare Standardized Payment Amount | 133754.79 |
| 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 | 161 |
| Number Of Medical Services | 5329 |
| Number Of Medicare Beneficiaries With Medical Services | 2464 |
| Total Medical Submitted Charge Amount | 185985.5 |
| Total Medical Medicare Allowed Amount | 164304.54 |
| Total Medical Medicare Payment Amount | 124602.8 |
| Total Medical Medicare Standardized Payment Amount | 133754.79 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 306 |
| Number Of Beneficiaries Age 65 to 74 | 836 |
| Number Of Beneficiaries Age 75 to 84 | 844 |
| Number Of Beneficiaries Age Greater 84 | 478 |
| Number Of Female Beneficiaries | 1563 |
| Number Of Male Beneficiaries | 901 |
| Number Of Non Hispanic White Beneficiaries | 2407 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2017 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 447 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2893 |