| National Provider Identifier [NPI]: | 1679529721 |
| Last Name Of The Provider | LOVE |
| First Name Of The Provider | RUSS |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 255 W LANCASTER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PAOLI |
| Zip Code Of The Provider | 193011763 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 125 |
| Number Of Services | 3977 |
| Number Of Medicare Beneficiaries | 2273 |
| Total Submitted Charge Amount | 542646.77 |
| Total Medicare Allowed Amount | 126375.83 |
| Total Medicare Payment Amount | 102130.1 |
| Total Medicare Standardized Payment Amount | 97914.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 227 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 926.77 |
| Total Drug Medicare AllowedAmount | 92.73 |
| Total Drug Medicare PaymentAmount | 72.74 |
| Total Drug Medicare Standardized Payment Amount | 72.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 124 |
| Number Of Medical Services | 3750 |
| Number Of Medicare Beneficiaries With Medical Services | 2273 |
| Total Medical Submitted Charge Amount | 541720 |
| Total Medical Medicare Allowed Amount | 126283.1 |
| Total Medical Medicare Payment Amount | 102057.36 |
| Total Medical Medicare Standardized Payment Amount | 97842.23 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 186 |
| Number Of Beneficiaries Age 65 to 74 | 933 |
| Number Of Beneficiaries Age 75 to 84 | 679 |
| Number Of Beneficiaries Age Greater 84 | 475 |
| Number Of Female Beneficiaries | 1622 |
| Number Of Male Beneficiaries | 651 |
| Number Of Non Hispanic White Beneficiaries | 1971 |
| Number Of Black or African American Beneficiaries | 211 |
| Number Of AsianPacific Islander Beneficiaries | 34 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2025 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 248 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.5652 |