| National Provider Identifier [NPI]: | 1265431092 |
| Last Name Of The Provider | ELLISON |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2142 W BROAD ST |
| Street Address 2 Of The Provider | BUILDING 200, SUITE 200 |
| City Of The Provider | ATHENS |
| Zip Code Of The Provider | 306063506 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 132 |
| Number Of Services | 13357 |
| Number Of Medicare Beneficiaries | 1086 |
| Total Submitted Charge Amount | 1297109.93 |
| Total Medicare Allowed Amount | 649884.92 |
| Total Medicare Payment Amount | 485753.8 |
| Total Medicare Standardized Payment Amount | 511080.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 6486 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 313513 |
| Total Drug Medicare AllowedAmount | 179335.08 |
| Total Drug Medicare PaymentAmount | 138121.92 |
| Total Drug Medicare Standardized Payment Amount | 138121.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 117 |
| Number Of Medical Services | 6871 |
| Number Of Medicare Beneficiaries With Medical Services | 1086 |
| Total Medical Submitted Charge Amount | 983596.93 |
| Total Medical Medicare Allowed Amount | 470549.84 |
| Total Medical Medicare Payment Amount | 347631.88 |
| Total Medical Medicare Standardized Payment Amount | 372958.71 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 110 |
| Number Of Beneficiaries Age 65 to 74 | 458 |
| Number Of Beneficiaries Age 75 to 84 | 394 |
| Number Of Beneficiaries Age Greater 84 | 124 |
| Number Of Female Beneficiaries | 357 |
| Number Of Male Beneficiaries | 729 |
| Number Of Non Hispanic White Beneficiaries | 943 |
| Number Of Black or African American Beneficiaries | 124 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 893 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 193 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2414 |