| National Provider Identifier [NPI]: | 1083642789 |
| Last Name Of The Provider | GIBSON |
| First Name Of The Provider | RUSSELL |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 423 E 23RD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW YORK |
| Zip Code Of The Provider | 100105011 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 114 |
| Number Of Services | 3763 |
| Number Of Medicare Beneficiaries | 2092 |
| Total Submitted Charge Amount | 269995 |
| Total Medicare Allowed Amount | 91667.48 |
| Total Medicare Payment Amount | 70662.45 |
| Total Medicare Standardized Payment Amount | 63394.24 |
| 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 | 114 |
| Number Of Medical Services | 3763 |
| Number Of Medicare Beneficiaries With Medical Services | 2092 |
| Total Medical Submitted Charge Amount | 269995 |
| Total Medical Medicare Allowed Amount | 91667.48 |
| Total Medical Medicare Payment Amount | 70662.45 |
| Total Medical Medicare Standardized Payment Amount | 63394.24 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 330 |
| Number Of Beneficiaries Age 65 to 74 | 650 |
| Number Of Beneficiaries Age 75 to 84 | 635 |
| Number Of Beneficiaries Age Greater 84 | 477 |
| Number Of Female Beneficiaries | 1307 |
| Number Of Male Beneficiaries | 785 |
| Number Of Non Hispanic White Beneficiaries | 958 |
| Number Of Black or African American Beneficiaries | 692 |
| Number Of AsianPacific Islander Beneficiaries | 74 |
| Number Of Hispanic Beneficiaries | 306 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 62 |
| Number Of Beneficiaries With Medicare Only Entitlement | 864 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1228 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 36 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 57 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.7765 |