| National Provider Identifier [NPI]: | 1841215282 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | CHRISTOPHER |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 540 CHAPEL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | MEXIA |
| Zip Code Of The Provider | 766673490 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 1511 |
| Number Of Medicare Beneficiaries | 103 |
| Total Submitted Charge Amount | 49301.15 |
| Total Medicare Allowed Amount | 46330.34 |
| Total Medicare Payment Amount | 37033.81 |
| Total Medicare Standardized Payment Amount | 38523.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 400 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 8511.83 |
| Total Drug Medicare AllowedAmount | 8477.89 |
| Total Drug Medicare PaymentAmount | 7289.99 |
| Total Drug Medicare Standardized Payment Amount | 7289.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 1111 |
| Number Of Medicare Beneficiaries With Medical Services | 103 |
| Total Medical Submitted Charge Amount | 40789.32 |
| Total Medical Medicare Allowed Amount | 37852.45 |
| Total Medical Medicare Payment Amount | 29743.82 |
| Total Medical Medicare Standardized Payment Amount | 31233.15 |
| Average Age Of Beneficiaries | 55 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 39 |
| Number Of Male Beneficiaries | 64 |
| Number Of Non Hispanic White Beneficiaries | 77 |
| 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 | 0 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 103 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 31 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 54 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 15 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 29 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.6594 |