| National Provider Identifier [NPI]: | 1194020511 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | JESSICA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA-C, MS |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3402 F ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191341225 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 261 |
| Number Of Medicare Beneficiaries | 68 |
| Total Submitted Charge Amount | 21455 |
| Total Medicare Allowed Amount | 14100.28 |
| Total Medicare Payment Amount | 9860.49 |
| Total Medicare Standardized Payment Amount | 11069.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 16 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 560 |
| Total Drug Medicare AllowedAmount | 335.4 |
| Total Drug Medicare PaymentAmount | 325.97 |
| Total Drug Medicare Standardized Payment Amount | 325.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 245 |
| Number Of Medicare Beneficiaries With Medical Services | 68 |
| Total Medical Submitted Charge Amount | 20895 |
| Total Medical Medicare Allowed Amount | 13764.88 |
| Total Medical Medicare Payment Amount | 9534.52 |
| Total Medical Medicare Standardized Payment Amount | 10743.12 |
| Average Age Of Beneficiaries | 53 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 40 |
| Number Of Male Beneficiaries | 28 |
| Number Of Non Hispanic White Beneficiaries | 50 |
| 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 | 21 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 68 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4181 |