| National Provider Identifier [NPI]: | 1689633067 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | BURTON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3601 W 13 MILE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROYAL OAK |
| Zip Code Of The Provider | 480736712 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 106 |
| Number Of Services | 8714 |
| Number Of Medicare Beneficiaries | 5159 |
| Total Submitted Charge Amount | 179951 |
| Total Medicare Allowed Amount | 107873.57 |
| Total Medicare Payment Amount | 76766.56 |
| Total Medicare Standardized Payment Amount | 73848.4 |
| 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 | 106 |
| Number Of Medical Services | 8714 |
| Number Of Medicare Beneficiaries With Medical Services | 5159 |
| Total Medical Submitted Charge Amount | 179951 |
| Total Medical Medicare Allowed Amount | 107873.57 |
| Total Medical Medicare Payment Amount | 76766.56 |
| Total Medical Medicare Standardized Payment Amount | 73848.4 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 760 |
| Number Of Beneficiaries Age 65 to 74 | 1955 |
| Number Of Beneficiaries Age 75 to 84 | 1530 |
| Number Of Beneficiaries Age Greater 84 | 914 |
| Number Of Female Beneficiaries | 3174 |
| Number Of Male Beneficiaries | 1985 |
| Number Of Non Hispanic White Beneficiaries | 4117 |
| Number Of Black or African American Beneficiaries | 834 |
| Number Of AsianPacific Islander Beneficiaries | 66 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 82 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4372 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 787 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6371 |