| National Provider Identifier [NPI]: | 1114969110 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | REUBEN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 791 POPLAR ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MACON |
| Zip Code Of The Provider | 312012045 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 83351 |
| Number Of Medicare Beneficiaries | 677 |
| Total Submitted Charge Amount | 5306375.93 |
| Total Medicare Allowed Amount | 2172419.45 |
| Total Medicare Payment Amount | 1685678.13 |
| Total Medicare Standardized Payment Amount | 1845010.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 76241 |
| Number Of Medicare Beneficiaries With Drug Services | 348 |
| Total Drug Submitted ChargeAmount | 67792.55 |
| Total Drug Medicare AllowedAmount | 22195.47 |
| Total Drug Medicare PaymentAmount | 17269.86 |
| Total Drug Medicare Standardized Payment Amount | 17269.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 7110 |
| Number Of Medicare Beneficiaries With Medical Services | 677 |
| Total Medical Submitted Charge Amount | 5238583.38 |
| Total Medical Medicare Allowed Amount | 2150223.98 |
| Total Medical Medicare Payment Amount | 1668408.27 |
| Total Medical Medicare Standardized Payment Amount | 1827740.26 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 286 |
| Number Of Beneficiaries Age 65 to 74 | 203 |
| Number Of Beneficiaries Age 75 to 84 | 140 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 328 |
| Number Of Male Beneficiaries | 349 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 421 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 389 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 288 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 54 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 5.2199 |