| National Provider Identifier [NPI]: | 1356341002 |
| Last Name Of The Provider | TACATA |
| First Name Of The Provider | RUSSELL |
| 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 | 1619 LILIHA STREET |
| Street Address 2 Of The Provider | #3 |
| City Of The Provider | HONOLULU |
| Zip Code Of The Provider | 968173152 |
| State Code Of The Provider | HI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 479 |
| Number Of Medicare Beneficiaries | 105 |
| Total Submitted Charge Amount | 54439.85 |
| Total Medicare Allowed Amount | 36721.07 |
| Total Medicare Payment Amount | 19638.03 |
| Total Medicare Standardized Payment Amount | 20837.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 37 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 1029.08 |
| Total Drug Medicare AllowedAmount | 570.33 |
| Total Drug Medicare PaymentAmount | 556.85 |
| Total Drug Medicare Standardized Payment Amount | 556.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 442 |
| Number Of Medicare Beneficiaries With Medical Services | 105 |
| Total Medical Submitted Charge Amount | 53410.77 |
| Total Medical Medicare Allowed Amount | 36150.74 |
| Total Medical Medicare Payment Amount | 19081.18 |
| Total Medical Medicare Standardized Payment Amount | 20280.23 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 48 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 55 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 64 |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 57 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 13 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.076 |