| National Provider Identifier [NPI]: | 1962464818 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 185 GENESEE ST |
| Street Address 2 Of The Provider | SUITE 600 |
| City Of The Provider | UTICA |
| Zip Code Of The Provider | 135012199 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 195 |
| Number Of Services | 15383 |
| Number Of Medicare Beneficiaries | 3162 |
| Total Submitted Charge Amount | 674455 |
| Total Medicare Allowed Amount | 240121.71 |
| Total Medicare Payment Amount | 179934.64 |
| Total Medicare Standardized Payment Amount | 191027.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 9940 |
| Number Of Medicare Beneficiaries With Drug Services | 113 |
| Total Drug Submitted ChargeAmount | 6840 |
| Total Drug Medicare AllowedAmount | 2840.77 |
| Total Drug Medicare PaymentAmount | 2182.81 |
| Total Drug Medicare Standardized Payment Amount | 2182.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 192 |
| Number Of Medical Services | 5443 |
| Number Of Medicare Beneficiaries With Medical Services | 3162 |
| Total Medical Submitted Charge Amount | 667615 |
| Total Medical Medicare Allowed Amount | 237280.94 |
| Total Medical Medicare Payment Amount | 177751.83 |
| Total Medical Medicare Standardized Payment Amount | 188845.05 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 633 |
| Number Of Beneficiaries Age 65 to 74 | 1006 |
| Number Of Beneficiaries Age 75 to 84 | 888 |
| Number Of Beneficiaries Age Greater 84 | 635 |
| Number Of Female Beneficiaries | 1932 |
| Number Of Male Beneficiaries | 1230 |
| Number Of Non Hispanic White Beneficiaries | 2961 |
| Number Of Black or African American Beneficiaries | 77 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 54 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2125 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1037 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6208 |