| National Provider Identifier [NPI]: | 1043384795 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21992 LORAIN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAIRVIEW PARK |
| Zip Code Of The Provider | 441263333 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 5193 |
| Number Of Medicare Beneficiaries | 839 |
| Total Submitted Charge Amount | 385758 |
| Total Medicare Allowed Amount | 261373.25 |
| Total Medicare Payment Amount | 188674.13 |
| Total Medicare Standardized Payment Amount | 202231.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 106 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 590 |
| Total Drug Medicare AllowedAmount | 184.58 |
| Total Drug Medicare PaymentAmount | 139 |
| Total Drug Medicare Standardized Payment Amount | 139 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 5087 |
| Number Of Medicare Beneficiaries With Medical Services | 839 |
| Total Medical Submitted Charge Amount | 385168 |
| Total Medical Medicare Allowed Amount | 261188.67 |
| Total Medical Medicare Payment Amount | 188535.13 |
| Total Medical Medicare Standardized Payment Amount | 202092.35 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 73 |
| Number Of Beneficiaries Age 65 to 74 | 167 |
| Number Of Beneficiaries Age 75 to 84 | 286 |
| Number Of Beneficiaries Age Greater 84 | 313 |
| Number Of Female Beneficiaries | 537 |
| Number Of Male Beneficiaries | 302 |
| Number Of Non Hispanic White Beneficiaries | 754 |
| 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 | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 419 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 420 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.759 |