| National Provider Identifier [NPI]: | 1053349415 |
| Last Name Of The Provider | ELLIOTT |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3205 S RUSSELL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MISSOULA |
| Zip Code Of The Provider | 598018536 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 206 |
| Number Of Services | 3379 |
| Number Of Medicare Beneficiaries | 2277 |
| Total Submitted Charge Amount | 403835 |
| Total Medicare Allowed Amount | 134568.88 |
| Total Medicare Payment Amount | 101778.53 |
| Total Medicare Standardized Payment Amount | 101490.64 |
| 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 | 206 |
| Number Of Medical Services | 3379 |
| Number Of Medicare Beneficiaries With Medical Services | 2277 |
| Total Medical Submitted Charge Amount | 403835 |
| Total Medical Medicare Allowed Amount | 134568.88 |
| Total Medical Medicare Payment Amount | 101778.53 |
| Total Medical Medicare Standardized Payment Amount | 101490.64 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 389 |
| Number Of Beneficiaries Age 65 to 74 | 910 |
| Number Of Beneficiaries Age 75 to 84 | 654 |
| Number Of Beneficiaries Age Greater 84 | 324 |
| Number Of Female Beneficiaries | 1175 |
| Number Of Male Beneficiaries | 1102 |
| Number Of Non Hispanic White Beneficiaries | 2098 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | 102 |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1755 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 522 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4523 |