| National Provider Identifier [NPI]: | 1063409639 |
| Last Name Of The Provider | BLAKELEY |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 606 N THIRD AVE |
| Street Address 2 Of The Provider | SUITE 203 |
| City Of The Provider | SANDPOINT |
| Zip Code Of The Provider | 838641594 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 2512 |
| Number Of Medicare Beneficiaries | 1219 |
| Total Submitted Charge Amount | 291417 |
| Total Medicare Allowed Amount | 97428.14 |
| Total Medicare Payment Amount | 71555.08 |
| Total Medicare Standardized Payment Amount | 76815.4 |
| 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 | 43 |
| Number Of Medical Services | 2512 |
| Number Of Medicare Beneficiaries With Medical Services | 1219 |
| Total Medical Submitted Charge Amount | 291417 |
| Total Medical Medicare Allowed Amount | 97428.14 |
| Total Medical Medicare Payment Amount | 71555.08 |
| Total Medical Medicare Standardized Payment Amount | 76815.4 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 215 |
| Number Of Beneficiaries Age 65 to 74 | 429 |
| Number Of Beneficiaries Age 75 to 84 | 390 |
| Number Of Beneficiaries Age Greater 84 | 185 |
| Number Of Female Beneficiaries | 601 |
| Number Of Male Beneficiaries | 618 |
| Number Of Non Hispanic White Beneficiaries | 1137 |
| Number Of Black or African American Beneficiaries | 60 |
| 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 | 864 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 355 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6932 |