| National Provider Identifier [NPI]: | 1437297264 |
| Last Name Of The Provider | ELLSWORTH |
| First Name Of The Provider | ELLEN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9930 JOHNNYCAKE RIDGE RD |
| Street Address 2 Of The Provider | SUITE 4B |
| City Of The Provider | MENTOR |
| Zip Code Of The Provider | 440606752 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 338 |
| Number Of Medicare Beneficiaries | 152 |
| Total Submitted Charge Amount | 11397.04 |
| Total Medicare Allowed Amount | 11115.57 |
| Total Medicare Payment Amount | 7410.78 |
| Total Medicare Standardized Payment Amount | 8872.17 |
| 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 | 9 |
| Number Of Medical Services | 338 |
| Number Of Medicare Beneficiaries With Medical Services | 152 |
| Total Medical Submitted Charge Amount | 11397.04 |
| Total Medical Medicare Allowed Amount | 11115.57 |
| Total Medical Medicare Payment Amount | 7410.78 |
| Total Medical Medicare Standardized Payment Amount | 8872.17 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 91 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 84 |
| Number Of Male Beneficiaries | 68 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 0.9339 |