| National Provider Identifier [NPI]: | 1548354178 |
| Last Name Of The Provider | ROUSSEL |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 329 WEST 40TH STREET |
| Street Address 2 Of The Provider | |
| City Of The Provider | SCOTTSBLUFF |
| Zip Code Of The Provider | 693614634 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 5175 |
| Number Of Medicare Beneficiaries | 1503 |
| Total Submitted Charge Amount | 1423476.76 |
| Total Medicare Allowed Amount | 787863.54 |
| Total Medicare Payment Amount | 586616.65 |
| Total Medicare Standardized Payment Amount | 618296.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 979 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 80010 |
| Total Drug Medicare AllowedAmount | 73503.53 |
| Total Drug Medicare PaymentAmount | 56501.78 |
| Total Drug Medicare Standardized Payment Amount | 56501.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 4196 |
| Number Of Medicare Beneficiaries With Medical Services | 1503 |
| Total Medical Submitted Charge Amount | 1343466.76 |
| Total Medical Medicare Allowed Amount | 714360.01 |
| Total Medical Medicare Payment Amount | 530114.87 |
| Total Medical Medicare Standardized Payment Amount | 561795.08 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 508 |
| Number Of Beneficiaries Age 75 to 84 | 632 |
| Number Of Beneficiaries Age Greater 84 | 316 |
| Number Of Female Beneficiaries | 919 |
| Number Of Male Beneficiaries | 584 |
| Number Of Non Hispanic White Beneficiaries | 1422 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1303 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 200 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0028 |