| National Provider Identifier [NPI]: | 1881601698 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | SARA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 496 SHOUP AVE W |
| Street Address 2 Of The Provider | SUITE E |
| City Of The Provider | TWIN FALLS |
| Zip Code Of The Provider | 83301 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 959 |
| Number Of Medicare Beneficiaries | 151 |
| Total Submitted Charge Amount | 47014.97 |
| Total Medicare Allowed Amount | 41557.22 |
| Total Medicare Payment Amount | 31996 |
| Total Medicare Standardized Payment Amount | 36299.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 38 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 547.64 |
| Total Drug Medicare AllowedAmount | 498.05 |
| Total Drug Medicare PaymentAmount | 487.66 |
| Total Drug Medicare Standardized Payment Amount | 487.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 921 |
| Number Of Medicare Beneficiaries With Medical Services | 151 |
| Total Medical Submitted Charge Amount | 46467.33 |
| Total Medical Medicare Allowed Amount | 41059.17 |
| Total Medical Medicare Payment Amount | 31508.34 |
| Total Medical Medicare Standardized Payment Amount | 35812.31 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 75 |
| Number Of Beneficiaries Age 75 to 84 | 55 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 127 |
| Number Of Male Beneficiaries | 24 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 11 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8321 |