| National Provider Identifier [NPI]: | 1144335696 |
| Last Name Of The Provider | FISHMAN |
| First Name Of The Provider | ELLIS |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3885 UPHAM ST |
| Street Address 2 Of The Provider | 100 |
| City Of The Provider | WHEAT RIDGE |
| Zip Code Of The Provider | 800334880 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Geriatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 5 |
| Number Of Services | 300 |
| Number Of Medicare Beneficiaries | 150 |
| Total Submitted Charge Amount | 53192 |
| Total Medicare Allowed Amount | 41017.22 |
| Total Medicare Payment Amount | 31616.53 |
| Total Medicare Standardized Payment Amount | 31689.94 |
| 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 | 5 |
| Number Of Medical Services | 300 |
| Number Of Medicare Beneficiaries With Medical Services | 150 |
| Total Medical Submitted Charge Amount | 53192 |
| Total Medical Medicare Allowed Amount | 41017.22 |
| Total Medical Medicare Payment Amount | 31616.53 |
| Total Medical Medicare Standardized Payment Amount | 31689.94 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 39 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 83 |
| Number Of Male Beneficiaries | 67 |
| Number Of Non Hispanic White Beneficiaries | 115 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 47 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 103 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 65 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 38 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.3405 |