| National Provider Identifier [NPI]: | 1174514574 |
| Last Name Of The Provider | BREISH |
| 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 | 8815 GERMANTOWN AVE |
| Street Address 2 Of The Provider | 5TH FLOOR |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191182722 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 944 |
| Number Of Medicare Beneficiaries | 339 |
| Total Submitted Charge Amount | 167500 |
| Total Medicare Allowed Amount | 65955.98 |
| Total Medicare Payment Amount | 50326.44 |
| Total Medicare Standardized Payment Amount | 47785.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 51 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 4165 |
| Total Drug Medicare AllowedAmount | 1367.28 |
| Total Drug Medicare PaymentAmount | 1339.59 |
| Total Drug Medicare Standardized Payment Amount | 1339.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 893 |
| Number Of Medicare Beneficiaries With Medical Services | 339 |
| Total Medical Submitted Charge Amount | 163335 |
| Total Medical Medicare Allowed Amount | 64588.7 |
| Total Medical Medicare Payment Amount | 48986.85 |
| Total Medical Medicare Standardized Payment Amount | 46445.51 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 86 |
| Number Of Beneficiaries Age 65 to 74 | 122 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 58 |
| Number Of Female Beneficiaries | 195 |
| Number Of Male Beneficiaries | 144 |
| Number Of Non Hispanic White Beneficiaries | 124 |
| Number Of Black or African American Beneficiaries | 200 |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 234 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 105 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5106 |