| National Provider Identifier [NPI]: | 1760630669 |
| Last Name Of The Provider | ELLISON |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7777 ALVARADO RD STE 108 |
| Street Address 2 Of The Provider | |
| City Of The Provider | LA MESA |
| Zip Code Of The Provider | 919428245 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 169 |
| Number Of Services | 6871 |
| Number Of Medicare Beneficiaries | 3372 |
| Total Submitted Charge Amount | 1034578 |
| Total Medicare Allowed Amount | 276461.9 |
| Total Medicare Payment Amount | 215548.43 |
| Total Medicare Standardized Payment Amount | 207977.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1191 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 3369 |
| Total Drug Medicare AllowedAmount | 476.03 |
| Total Drug Medicare PaymentAmount | 342.25 |
| Total Drug Medicare Standardized Payment Amount | 342.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 167 |
| Number Of Medical Services | 5680 |
| Number Of Medicare Beneficiaries With Medical Services | 3372 |
| Total Medical Submitted Charge Amount | 1031209 |
| Total Medical Medicare Allowed Amount | 275985.87 |
| Total Medical Medicare Payment Amount | 215206.18 |
| Total Medical Medicare Standardized Payment Amount | 207635.07 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 715 |
| Number Of Beneficiaries Age 65 to 74 | 1193 |
| Number Of Beneficiaries Age 75 to 84 | 909 |
| Number Of Beneficiaries Age Greater 84 | 555 |
| Number Of Female Beneficiaries | 2145 |
| Number Of Male Beneficiaries | 1227 |
| Number Of Non Hispanic White Beneficiaries | 2448 |
| Number Of Black or African American Beneficiaries | 211 |
| Number Of AsianPacific Islander Beneficiaries | 160 |
| Number Of Hispanic Beneficiaries | 433 |
| Number Of American Indian Alaska Native Beneficiaries | 35 |
| Number Of Beneficiaries With Race Not Else where Classified | 85 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1839 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1533 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 37 |
| 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 | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.9389 |