| National Provider Identifier [NPI]: | 1780639039 |
| Last Name Of The Provider | ELLISON |
| First Name Of The Provider | HARRY |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8881 FLETCHER PARKWAY |
| Street Address 2 Of The Provider | #102 |
| City Of The Provider | LA MESA |
| Zip Code Of The Provider | 91942 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 157 |
| Number Of Services | 6731 |
| Number Of Medicare Beneficiaries | 3138 |
| Total Submitted Charge Amount | 870410 |
| Total Medicare Allowed Amount | 250097.12 |
| Total Medicare Payment Amount | 200353.96 |
| Total Medicare Standardized Payment Amount | 192574.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1500 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 3000 |
| Total Drug Medicare AllowedAmount | 338.56 |
| Total Drug Medicare PaymentAmount | 265.42 |
| Total Drug Medicare Standardized Payment Amount | 265.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 156 |
| Number Of Medical Services | 5231 |
| Number Of Medicare Beneficiaries With Medical Services | 3138 |
| Total Medical Submitted Charge Amount | 867410 |
| Total Medical Medicare Allowed Amount | 249758.56 |
| Total Medical Medicare Payment Amount | 200088.54 |
| Total Medical Medicare Standardized Payment Amount | 192309.49 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 606 |
| Number Of Beneficiaries Age 65 to 74 | 1138 |
| Number Of Beneficiaries Age 75 to 84 | 859 |
| Number Of Beneficiaries Age Greater 84 | 535 |
| Number Of Female Beneficiaries | 2080 |
| Number Of Male Beneficiaries | 1058 |
| Number Of Non Hispanic White Beneficiaries | 2319 |
| Number Of Black or African American Beneficiaries | 168 |
| Number Of AsianPacific Islander Beneficiaries | 150 |
| Number Of Hispanic Beneficiaries | 395 |
| Number Of American Indian Alaska Native Beneficiaries | 21 |
| Number Of Beneficiaries With Race Not Else where Classified | 85 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1821 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1317 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.9051 |