| National Provider Identifier [NPI]: | 1962425462 |
| Last Name Of The Provider | GOLDBERG |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13014 120TH AVE NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | KIRKLAND |
| Zip Code Of The Provider | 980343015 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 3989 |
| Number Of Medicare Beneficiaries | 666 |
| Total Submitted Charge Amount | 504303.79 |
| Total Medicare Allowed Amount | 188606.45 |
| Total Medicare Payment Amount | 139150.64 |
| Total Medicare Standardized Payment Amount | 130530.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 1228 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 21625.79 |
| Total Drug Medicare AllowedAmount | 8660.27 |
| Total Drug Medicare PaymentAmount | 7170.2 |
| Total Drug Medicare Standardized Payment Amount | 7170.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 2761 |
| Number Of Medicare Beneficiaries With Medical Services | 666 |
| Total Medical Submitted Charge Amount | 482678 |
| Total Medical Medicare Allowed Amount | 179946.18 |
| Total Medical Medicare Payment Amount | 131980.44 |
| Total Medical Medicare Standardized Payment Amount | 123360.4 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 292 |
| Number Of Beneficiaries Age 75 to 84 | 248 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 293 |
| Number Of Male Beneficiaries | 373 |
| Number Of Non Hispanic White Beneficiaries | 604 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 612 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0084 |