| National Provider Identifier [NPI]: | 1679688774 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 915 SUMMIT AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | OCONOMOWOC |
| Zip Code Of The Provider | 530663994 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 1952 |
| Number Of Medicare Beneficiaries | 861 |
| Total Submitted Charge Amount | 1295828 |
| Total Medicare Allowed Amount | 280476.3 |
| Total Medicare Payment Amount | 199008.95 |
| Total Medicare Standardized Payment Amount | 206890.46 |
| 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 | 49 |
| Number Of Medical Services | 1952 |
| Number Of Medicare Beneficiaries With Medical Services | 861 |
| Total Medical Submitted Charge Amount | 1295828 |
| Total Medical Medicare Allowed Amount | 280476.3 |
| Total Medical Medicare Payment Amount | 199008.95 |
| Total Medical Medicare Standardized Payment Amount | 206890.46 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 332 |
| Number Of Beneficiaries Age 75 to 84 | 333 |
| Number Of Beneficiaries Age Greater 84 | 168 |
| Number Of Female Beneficiaries | 535 |
| Number Of Male Beneficiaries | 326 |
| Number Of Non Hispanic White Beneficiaries | 835 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 833 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9544 |