| National Provider Identifier [NPI]: | 1386748747 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 192 W CENTER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILLERSBURG |
| Zip Code Of The Provider | 170611314 |
| 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 | 31 |
| Number Of Services | 2257 |
| Number Of Medicare Beneficiaries | 338 |
| Total Submitted Charge Amount | 99672 |
| Total Medicare Allowed Amount | 94526.81 |
| Total Medicare Payment Amount | 64387.33 |
| Total Medicare Standardized Payment Amount | 68018.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 91 |
| Number Of Medicare Beneficiaries With Drug Services | 87 |
| Total Drug Submitted ChargeAmount | 1685 |
| Total Drug Medicare AllowedAmount | 1420.83 |
| Total Drug Medicare PaymentAmount | 1392.48 |
| Total Drug Medicare Standardized Payment Amount | 1392.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 2166 |
| Number Of Medicare Beneficiaries With Medical Services | 338 |
| Total Medical Submitted Charge Amount | 97987 |
| Total Medical Medicare Allowed Amount | 93105.98 |
| Total Medical Medicare Payment Amount | 62994.85 |
| Total Medical Medicare Standardized Payment Amount | 66625.9 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 95 |
| Number Of Beneficiaries Age 75 to 84 | 126 |
| Number Of Beneficiaries Age Greater 84 | 92 |
| Number Of Female Beneficiaries | 204 |
| Number Of Male Beneficiaries | 134 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 260 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 78 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1302 |