| National Provider Identifier [NPI]: | 1447256102 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9207 HIGHWAY 71 S |
| Street Address 2 Of The Provider | SUITE 9 |
| City Of The Provider | FORT SMITH |
| Zip Code Of The Provider | 729169117 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 81 |
| Number Of Services | 20891 |
| Number Of Medicare Beneficiaries | 2459 |
| Total Submitted Charge Amount | 1400141.09 |
| Total Medicare Allowed Amount | 1056473.69 |
| Total Medicare Payment Amount | 779519.8 |
| Total Medicare Standardized Payment Amount | 855181.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 592 |
| Number Of Medicare Beneficiaries With Drug Services | 271 |
| Total Drug Submitted ChargeAmount | 129210 |
| Total Drug Medicare AllowedAmount | 120100.57 |
| Total Drug Medicare PaymentAmount | 93038.63 |
| Total Drug Medicare Standardized Payment Amount | 93038.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 20299 |
| Number Of Medicare Beneficiaries With Medical Services | 2459 |
| Total Medical Submitted Charge Amount | 1270931.09 |
| Total Medical Medicare Allowed Amount | 936373.12 |
| Total Medical Medicare Payment Amount | 686481.17 |
| Total Medical Medicare Standardized Payment Amount | 762142.46 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 256 |
| Number Of Beneficiaries Age 65 to 74 | 1287 |
| Number Of Beneficiaries Age 75 to 84 | 716 |
| Number Of Beneficiaries Age Greater 84 | 200 |
| Number Of Female Beneficiaries | 1535 |
| Number Of Male Beneficiaries | 924 |
| Number Of Non Hispanic White Beneficiaries | 2324 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 87 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2153 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 306 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8997 |