| National Provider Identifier [NPI]: | 1730150194 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1765 OLD WEST BROAD ST |
| Street Address 2 Of The Provider | BLDG 1 STE 200 |
| City Of The Provider | ATHENS |
| Zip Code Of The Provider | 306062867 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 104 |
| Number Of Services | 62459 |
| Number Of Medicare Beneficiaries | 1509 |
| Total Submitted Charge Amount | 5675390.5 |
| Total Medicare Allowed Amount | 2542181.63 |
| Total Medicare Payment Amount | 2148650.9 |
| Total Medicare Standardized Payment Amount | 2119879.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 764 |
| Number Of Medicare Beneficiaries With Drug Services | 230 |
| Total Drug Submitted ChargeAmount | 15640 |
| Total Drug Medicare AllowedAmount | 2165.02 |
| Total Drug Medicare PaymentAmount | 1662.21 |
| Total Drug Medicare Standardized Payment Amount | 1662.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 61695 |
| Number Of Medicare Beneficiaries With Medical Services | 1509 |
| Total Medical Submitted Charge Amount | 5659750.5 |
| Total Medical Medicare Allowed Amount | 2540016.61 |
| Total Medical Medicare Payment Amount | 2146988.69 |
| Total Medical Medicare Standardized Payment Amount | 2118217.66 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 971 |
| Number Of Beneficiaries Age 65 to 74 | 388 |
| Number Of Beneficiaries Age 75 to 84 | 124 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 861 |
| Number Of Male Beneficiaries | 648 |
| Number Of Non Hispanic White Beneficiaries | 1191 |
| Number Of Black or African American Beneficiaries | 292 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 746 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 763 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.4336 |