| National Provider Identifier [NPI]: | 1568465920 |
| Last Name Of The Provider | ROBERTSON |
| First Name Of The Provider | ELLIS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12700 PARK CENTRAL DR |
| Street Address 2 Of The Provider | STE 430 |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752511527 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 99 |
| Number Of Services | 3521 |
| Number Of Medicare Beneficiaries | 2494 |
| Total Submitted Charge Amount | 640882 |
| Total Medicare Allowed Amount | 181570.64 |
| Total Medicare Payment Amount | 140207.67 |
| Total Medicare Standardized Payment Amount | 142796.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 3521 |
| Number Of Medicare Beneficiaries With Medical Services | 2494 |
| Total Medical Submitted Charge Amount | 640882 |
| Total Medical Medicare Allowed Amount | 181570.64 |
| Total Medical Medicare Payment Amount | 140207.67 |
| Total Medical Medicare Standardized Payment Amount | 142796.43 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 464 |
| Number Of Beneficiaries Age 65 to 74 | 983 |
| Number Of Beneficiaries Age 75 to 84 | 686 |
| Number Of Beneficiaries Age Greater 84 | 361 |
| Number Of Female Beneficiaries | 1432 |
| Number Of Male Beneficiaries | 1062 |
| Number Of Non Hispanic White Beneficiaries | 1923 |
| Number Of Black or African American Beneficiaries | 295 |
| Number Of AsianPacific Islander Beneficiaries | 59 |
| Number Of Hispanic Beneficiaries | 184 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1977 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 517 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.6963 |