| National Provider Identifier [NPI]: | 1588635361 |
| Last Name Of The Provider | GRIMES |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1005 W SAINT MAARTENS DR STE A |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT JOSEPH |
| Zip Code Of The Provider | 645062989 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 5360 |
| Number Of Medicare Beneficiaries | 968 |
| Total Submitted Charge Amount | 335032.12 |
| Total Medicare Allowed Amount | 283457.75 |
| Total Medicare Payment Amount | 203259.66 |
| Total Medicare Standardized Payment Amount | 233141.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 243 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 1043.28 |
| Total Drug Medicare AllowedAmount | 357.18 |
| Total Drug Medicare PaymentAmount | 257.51 |
| Total Drug Medicare Standardized Payment Amount | 257.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 5117 |
| Number Of Medicare Beneficiaries With Medical Services | 968 |
| Total Medical Submitted Charge Amount | 333988.84 |
| Total Medical Medicare Allowed Amount | 283100.57 |
| Total Medical Medicare Payment Amount | 203002.15 |
| Total Medical Medicare Standardized Payment Amount | 232883.61 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 98 |
| Number Of Beneficiaries Age 65 to 74 | 325 |
| Number Of Beneficiaries Age 75 to 84 | 332 |
| Number Of Beneficiaries Age Greater 84 | 213 |
| Number Of Female Beneficiaries | 594 |
| Number Of Male Beneficiaries | 374 |
| Number Of Non Hispanic White Beneficiaries | 924 |
| Number Of Black or African American Beneficiaries | 25 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 855 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 113 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5048 |