| National Provider Identifier [NPI]: | 1376734210 |
| Last Name Of The Provider | WARDLAW |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16061 DOCTORS BLVD |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | HAMMOND |
| Zip Code Of The Provider | 704031499 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Gastroenterology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 2171 |
| Number Of Medicare Beneficiaries | 687 |
| Total Submitted Charge Amount | 826919 |
| Total Medicare Allowed Amount | 243069.19 |
| Total Medicare Payment Amount | 185238.84 |
| Total Medicare Standardized Payment Amount | 196778.68 |
| 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 | 53 |
| Number Of Medical Services | 2171 |
| Number Of Medicare Beneficiaries With Medical Services | 687 |
| Total Medical Submitted Charge Amount | 826919 |
| Total Medical Medicare Allowed Amount | 243069.19 |
| Total Medical Medicare Payment Amount | 185238.84 |
| Total Medical Medicare Standardized Payment Amount | 196778.68 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 147 |
| Number Of Beneficiaries Age 65 to 74 | 282 |
| Number Of Beneficiaries Age 75 to 84 | 165 |
| Number Of Beneficiaries Age Greater 84 | 93 |
| Number Of Female Beneficiaries | 440 |
| Number Of Male Beneficiaries | 247 |
| Number Of Non Hispanic White Beneficiaries | 548 |
| Number Of Black or African American Beneficiaries | 110 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 437 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 250 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 52 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.4303 |