| National Provider Identifier [NPI]: | 1154385193 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4350 TOWNE CENTRE DR |
| Street Address 2 Of The Provider | SUITE 1000 |
| City Of The Provider | EVANS |
| Zip Code Of The Provider | 308093301 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 192 |
| Number Of Services | 5179 |
| Number Of Medicare Beneficiaries | 3423 |
| Total Submitted Charge Amount | 972677 |
| Total Medicare Allowed Amount | 173725.79 |
| Total Medicare Payment Amount | 134620.62 |
| Total Medicare Standardized Payment Amount | 140646.32 |
| 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 | 192 |
| Number Of Medical Services | 5179 |
| Number Of Medicare Beneficiaries With Medical Services | 3423 |
| Total Medical Submitted Charge Amount | 972677 |
| Total Medical Medicare Allowed Amount | 173725.79 |
| Total Medical Medicare Payment Amount | 134620.62 |
| Total Medical Medicare Standardized Payment Amount | 140646.32 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 685 |
| Number Of Beneficiaries Age 65 to 74 | 1241 |
| Number Of Beneficiaries Age 75 to 84 | 975 |
| Number Of Beneficiaries Age Greater 84 | 522 |
| Number Of Female Beneficiaries | 2022 |
| Number Of Male Beneficiaries | 1401 |
| Number Of Non Hispanic White Beneficiaries | 2397 |
| Number Of Black or African American Beneficiaries | 950 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2525 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 898 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.0433 |