| National Provider Identifier [NPI]: | 1750345898 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7575 OSCEOLA POLK LINE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAVENPORT |
| Zip Code Of The Provider | 338969112 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 188 |
| Number Of Medicare Beneficiaries | 117 |
| Total Submitted Charge Amount | 10530.56 |
| Total Medicare Allowed Amount | 9627.79 |
| Total Medicare Payment Amount | 5653.87 |
| Total Medicare Standardized Payment Amount | 7089.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 1355.56 |
| Total Drug Medicare AllowedAmount | 1355.56 |
| Total Drug Medicare PaymentAmount | 1317.67 |
| Total Drug Medicare Standardized Payment Amount | 1317.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 144 |
| Number Of Medicare Beneficiaries With Medical Services | 116 |
| Total Medical Submitted Charge Amount | 9175 |
| Total Medical Medicare Allowed Amount | 8272.23 |
| Total Medical Medicare Payment Amount | 4336.2 |
| Total Medical Medicare Standardized Payment Amount | 5772.29 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 70 |
| Number Of Male Beneficiaries | 47 |
| 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 | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8014 |