| National Provider Identifier [NPI]: | 1205970365 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | LARRY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 NORTH MAIN |
| Street Address 2 Of The Provider | |
| City Of The Provider | HARRISON |
| Zip Code Of The Provider | 726012911 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 605 |
| Number Of Medicare Beneficiaries | 430 |
| Total Submitted Charge Amount | 136024 |
| Total Medicare Allowed Amount | 37211.25 |
| Total Medicare Payment Amount | 26524.9 |
| Total Medicare Standardized Payment Amount | 33741.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 57 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 166 |
| Total Drug Medicare AllowedAmount | 33.34 |
| Total Drug Medicare PaymentAmount | 28.54 |
| Total Drug Medicare Standardized Payment Amount | 28.54 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 548 |
| Number Of Medicare Beneficiaries With Medical Services | 430 |
| Total Medical Submitted Charge Amount | 135858 |
| Total Medical Medicare Allowed Amount | 37177.91 |
| Total Medical Medicare Payment Amount | 26496.36 |
| Total Medical Medicare Standardized Payment Amount | 33712.48 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 156 |
| Number Of Beneficiaries Age 65 to 74 | 124 |
| Number Of Beneficiaries Age 75 to 84 | 104 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 254 |
| Number Of Male Beneficiaries | 176 |
| 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 | 242 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 188 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3018 |