| National Provider Identifier [NPI]: | 1336101005 |
| Last Name Of The Provider | RUSNACK |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 601 FRONT AVENUE |
| Street Address 2 Of The Provider | SUITE #502 |
| City Of The Provider | COEUR D ALENE |
| Zip Code Of The Provider | 83814 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 155 |
| Number Of Services | 23949 |
| Number Of Medicare Beneficiaries | 2445 |
| Total Submitted Charge Amount | 1316891.95 |
| Total Medicare Allowed Amount | 318107.69 |
| Total Medicare Payment Amount | 247124.19 |
| Total Medicare Standardized Payment Amount | 229381.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 20506 |
| Number Of Medicare Beneficiaries With Drug Services | 240 |
| Total Drug Submitted ChargeAmount | 20980.95 |
| Total Drug Medicare AllowedAmount | 5933.9 |
| Total Drug Medicare PaymentAmount | 4652.22 |
| Total Drug Medicare Standardized Payment Amount | 4652.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 151 |
| Number Of Medical Services | 3443 |
| Number Of Medicare Beneficiaries With Medical Services | 2445 |
| Total Medical Submitted Charge Amount | 1295911 |
| Total Medical Medicare Allowed Amount | 312173.79 |
| Total Medical Medicare Payment Amount | 242471.97 |
| Total Medical Medicare Standardized Payment Amount | 224729.69 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 589 |
| Number Of Beneficiaries Age 65 to 74 | 742 |
| Number Of Beneficiaries Age 75 to 84 | 697 |
| Number Of Beneficiaries Age Greater 84 | 417 |
| Number Of Female Beneficiaries | 1407 |
| Number Of Male Beneficiaries | 1038 |
| Number Of Non Hispanic White Beneficiaries | 1212 |
| Number Of Black or African American Beneficiaries | 410 |
| Number Of AsianPacific Islander Beneficiaries | 282 |
| Number Of Hispanic Beneficiaries | 500 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1065 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1380 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.355 |