| National Provider Identifier [NPI]: | 1194011494 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3927 RUCKER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | EVERETT |
| Zip Code Of The Provider | 982014833 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 748 |
| Number Of Medicare Beneficiaries | 243 |
| Total Submitted Charge Amount | 72577.25 |
| Total Medicare Allowed Amount | 26659.22 |
| Total Medicare Payment Amount | 16873.12 |
| Total Medicare Standardized Payment Amount | 21388.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 176 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 712.75 |
| Total Drug Medicare AllowedAmount | 147.86 |
| Total Drug Medicare PaymentAmount | 124.32 |
| Total Drug Medicare Standardized Payment Amount | 124.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 69 |
| Number Of Medical Services | 572 |
| Number Of Medicare Beneficiaries With Medical Services | 243 |
| Total Medical Submitted Charge Amount | 71864.5 |
| Total Medical Medicare Allowed Amount | 26511.36 |
| Total Medical Medicare Payment Amount | 16748.8 |
| Total Medical Medicare Standardized Payment Amount | 21264.02 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 103 |
| Number Of Beneficiaries Age 75 to 84 | 69 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 145 |
| Number Of Male Beneficiaries | 98 |
| Number Of Non Hispanic White Beneficiaries | 224 |
| Number Of Black or African American Beneficiaries | |
| 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 | 199 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 44 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.092 |