National Provider Identifier [NPI]: |
1073576062 |
Last Name Of The Provider |
JOHNSON |
First Name Of The Provider |
TEDDY |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
DPM |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
680 W MONROE ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
WYTHEVILLE |
Zip Code Of The Provider |
243822240 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Podiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
57 |
Number Of Services |
3003 |
Number Of Medicare Beneficiaries |
1167 |
Total Submitted Charge Amount |
307861.5 |
Total Medicare Allowed Amount |
175139.81 |
Total Medicare Payment Amount |
122130.71 |
Total Medicare Standardized Payment Amount |
126978.45 |
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 |
57 |
Number Of Medical Services |
3003 |
Number Of Medicare Beneficiaries With Medical Services |
1167 |
Total Medical Submitted Charge Amount |
307861.5 |
Total Medical Medicare Allowed Amount |
175139.81 |
Total Medical Medicare Payment Amount |
122130.71 |
Total Medical Medicare Standardized Payment Amount |
126978.45 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
167 |
Number Of Beneficiaries Age 65 to 74 |
384 |
Number Of Beneficiaries Age 75 to 84 |
399 |
Number Of Beneficiaries Age Greater 84 |
217 |
Number Of Female Beneficiaries |
682 |
Number Of Male Beneficiaries |
485 |
Number Of Non Hispanic White Beneficiaries |
1117 |
Number Of Black or African American Beneficiaries |
34 |
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 |
904 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
263 |
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
25 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
48 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
41 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.4673 |