| National Provider Identifier [NPI]: | 1871562967 |
| Last Name Of The Provider | VANDERWILDE |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 601 W 5TH AVE |
| Street Address 2 Of The Provider | SUITE 400 |
| City Of The Provider | SPOKANE |
| Zip Code Of The Provider | 992042715 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Sports Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 1127 |
| Number Of Medicare Beneficiaries | 318 |
| Total Submitted Charge Amount | 648754 |
| Total Medicare Allowed Amount | 177084.37 |
| Total Medicare Payment Amount | 128779.76 |
| Total Medicare Standardized Payment Amount | 138331 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 114 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 2417 |
| Total Drug Medicare AllowedAmount | 1134.75 |
| Total Drug Medicare PaymentAmount | 881.24 |
| Total Drug Medicare Standardized Payment Amount | 881.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 1013 |
| Number Of Medicare Beneficiaries With Medical Services | 318 |
| Total Medical Submitted Charge Amount | 646337 |
| Total Medical Medicare Allowed Amount | 175949.62 |
| Total Medical Medicare Payment Amount | 127898.52 |
| Total Medical Medicare Standardized Payment Amount | 137449.76 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 201 |
| Number Of Beneficiaries Age 75 to 84 | 81 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 142 |
| Number Of Male Beneficiaries | 176 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 296 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 64 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.7483 |