| National Provider Identifier [NPI]: | 1215981022 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1213 24TH ST |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | ANACORTES |
| Zip Code Of The Provider | 982212592 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 6224 |
| Number Of Medicare Beneficiaries | 1803 |
| Total Submitted Charge Amount | 1572112 |
| Total Medicare Allowed Amount | 920450.28 |
| Total Medicare Payment Amount | 673641.96 |
| Total Medicare Standardized Payment Amount | 678650.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 347 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 281900 |
| Total Drug Medicare AllowedAmount | 267900.72 |
| Total Drug Medicare PaymentAmount | 210033.85 |
| Total Drug Medicare Standardized Payment Amount | 210033.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 5877 |
| Number Of Medicare Beneficiaries With Medical Services | 1803 |
| Total Medical Submitted Charge Amount | 1290212 |
| Total Medical Medicare Allowed Amount | 652549.56 |
| Total Medical Medicare Payment Amount | 463608.11 |
| Total Medical Medicare Standardized Payment Amount | 468616.2 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 812 |
| Number Of Beneficiaries Age 75 to 84 | 648 |
| Number Of Beneficiaries Age Greater 84 | 280 |
| Number Of Female Beneficiaries | 1008 |
| Number Of Male Beneficiaries | 795 |
| Number Of Non Hispanic White Beneficiaries | 1704 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 23 |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1667 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 136 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8722 |