| National Provider Identifier [NPI]: | 1659353480 |
| Last Name Of The Provider | RUSSELL |
| First Name Of The Provider | PHILLIP |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 816 S WALNUT ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | STILLWATER |
| Zip Code Of The Provider | 740744225 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 183 |
| Number Of Services | 9615 |
| Number Of Medicare Beneficiaries | 4241 |
| Total Submitted Charge Amount | 842004 |
| Total Medicare Allowed Amount | 258919.69 |
| Total Medicare Payment Amount | 191692.05 |
| Total Medicare Standardized Payment Amount | 204935.22 |
| 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 | 183 |
| Number Of Medical Services | 9615 |
| Number Of Medicare Beneficiaries With Medical Services | 4241 |
| Total Medical Submitted Charge Amount | 842004 |
| Total Medical Medicare Allowed Amount | 258919.69 |
| Total Medical Medicare Payment Amount | 191692.05 |
| Total Medical Medicare Standardized Payment Amount | 204935.22 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 646 |
| Number Of Beneficiaries Age 65 to 74 | 1646 |
| Number Of Beneficiaries Age 75 to 84 | 1327 |
| Number Of Beneficiaries Age Greater 84 | 622 |
| Number Of Female Beneficiaries | 2823 |
| Number Of Male Beneficiaries | 1418 |
| Number Of Non Hispanic White Beneficiaries | 3878 |
| Number Of Black or African American Beneficiaries | 109 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | 175 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3465 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 776 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2254 |