| National Provider Identifier [NPI]: | 1093864118 |
| Last Name Of The Provider | ELLINGSON |
| First Name Of The Provider | ANDREW |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 615 VALLEY VIEW DR |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | MOLINE |
| Zip Code Of The Provider | 612656180 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 185 |
| Number Of Services | 7355 |
| Number Of Medicare Beneficiaries | 4631 |
| Total Submitted Charge Amount | 818585.02 |
| Total Medicare Allowed Amount | 240830 |
| Total Medicare Payment Amount | 188593.53 |
| Total Medicare Standardized Payment Amount | 195814.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 266 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 1909.25 |
| Total Drug Medicare AllowedAmount | 523.97 |
| Total Drug Medicare PaymentAmount | 410.84 |
| Total Drug Medicare Standardized Payment Amount | 410.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 184 |
| Number Of Medical Services | 7089 |
| Number Of Medicare Beneficiaries With Medical Services | 4631 |
| Total Medical Submitted Charge Amount | 816675.77 |
| Total Medical Medicare Allowed Amount | 240306.03 |
| Total Medical Medicare Payment Amount | 188182.69 |
| Total Medical Medicare Standardized Payment Amount | 195403.28 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 609 |
| Number Of Beneficiaries Age 65 to 74 | 1780 |
| Number Of Beneficiaries Age 75 to 84 | 1432 |
| Number Of Beneficiaries Age Greater 84 | 810 |
| Number Of Female Beneficiaries | 2861 |
| Number Of Male Beneficiaries | 1770 |
| Number Of Non Hispanic White Beneficiaries | 4246 |
| Number Of Black or African American Beneficiaries | 200 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 119 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3744 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 887 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4015 |