| National Provider Identifier [NPI]: | 1487607537 |
| Last Name Of The Provider | ELLA |
| First Name Of The Provider | CONWAY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | CRNA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 412 DEVONIA ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | HARRIMAN |
| Zip Code Of The Provider | 377482009 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | CRNA |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 746 |
| Number Of Medicare Beneficiaries | 465 |
| Total Submitted Charge Amount | 650000 |
| Total Medicare Allowed Amount | 124437.02 |
| Total Medicare Payment Amount | 96903.47 |
| Total Medicare Standardized Payment Amount | 102997.98 |
| 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 | 9 |
| Number Of Medical Services | 746 |
| Number Of Medicare Beneficiaries With Medical Services | 465 |
| Total Medical Submitted Charge Amount | 650000 |
| Total Medical Medicare Allowed Amount | 124437.02 |
| Total Medical Medicare Payment Amount | 96903.47 |
| Total Medical Medicare Standardized Payment Amount | 102997.98 |
| Average Age Of Beneficiaries | 57 |
| Number Of Beneficiaries Age Less65 | 344 |
| Number Of Beneficiaries Age 65 to 74 | 102 |
| Number Of Beneficiaries Age 75 to 84 | 19 |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 261 |
| Number Of Male Beneficiaries | 204 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 160 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 305 |
| Percent Of With Atrial Fibrillation | 3 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 3 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 48 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2407 |