| National Provider Identifier [NPI]: | 1376582163 |
| Last Name Of The Provider | PERRY |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 RIVER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT BRAGG |
| Zip Code Of The Provider | 954375403 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 239 |
| Number Of Services | 8739 |
| Number Of Medicare Beneficiaries | 2845 |
| Total Submitted Charge Amount | 646116 |
| Total Medicare Allowed Amount | 255850.73 |
| Total Medicare Payment Amount | 186732.02 |
| Total Medicare Standardized Payment Amount | 184588.05 |
| 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 | 239 |
| Number Of Medical Services | 8739 |
| Number Of Medicare Beneficiaries With Medical Services | 2845 |
| Total Medical Submitted Charge Amount | 646116 |
| Total Medical Medicare Allowed Amount | 255850.73 |
| Total Medical Medicare Payment Amount | 186732.02 |
| Total Medical Medicare Standardized Payment Amount | 184588.05 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 400 |
| Number Of Beneficiaries Age 65 to 74 | 1381 |
| Number Of Beneficiaries Age 75 to 84 | 691 |
| Number Of Beneficiaries Age Greater 84 | 373 |
| Number Of Female Beneficiaries | 1720 |
| Number Of Male Beneficiaries | 1125 |
| Number Of Non Hispanic White Beneficiaries | 2607 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 108 |
| Number Of American Indian Alaska Native Beneficiaries | 43 |
| Number Of Beneficiaries With Race Not Else where Classified | 47 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2103 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 742 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9722 |