| National Provider Identifier [NPI]: | 1073573168 |
| Last Name Of The Provider | ELLISON |
| First Name Of The Provider | GREGG |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1105 LAS TABLAS RD |
| Street Address 2 Of The Provider | STE F |
| City Of The Provider | TEMPLETON |
| Zip Code Of The Provider | 934659731 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 4276 |
| Number Of Medicare Beneficiaries | 515 |
| Total Submitted Charge Amount | 332423.1 |
| Total Medicare Allowed Amount | 280358.93 |
| Total Medicare Payment Amount | 210962.8 |
| Total Medicare Standardized Payment Amount | 212942.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 459 |
| Number Of Medicare Beneficiaries With Drug Services | 308 |
| Total Drug Submitted ChargeAmount | 15481.84 |
| Total Drug Medicare AllowedAmount | 7446.25 |
| Total Drug Medicare PaymentAmount | 7236.52 |
| Total Drug Medicare Standardized Payment Amount | 7236.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 3817 |
| Number Of Medicare Beneficiaries With Medical Services | 514 |
| Total Medical Submitted Charge Amount | 316941.26 |
| Total Medical Medicare Allowed Amount | 272912.68 |
| Total Medical Medicare Payment Amount | 203726.28 |
| Total Medical Medicare Standardized Payment Amount | 205705.64 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 212 |
| Number Of Beneficiaries Age 75 to 84 | 200 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 270 |
| Number Of Male Beneficiaries | 245 |
| Number Of Non Hispanic White Beneficiaries | 489 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| 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 | 11 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.0341 |