| National Provider Identifier [NPI]: | 1043233760 |
| Last Name Of The Provider | GRANT |
| First Name Of The Provider | ELLSWORTH |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1245 WILSHIRE BLVD |
| Street Address 2 Of The Provider | SUITE 801 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900174810 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 92 |
| Number Of Services | 49052 |
| Number Of Medicare Beneficiaries | 157 |
| Total Submitted Charge Amount | 3477710.03 |
| Total Medicare Allowed Amount | 1520853.06 |
| Total Medicare Payment Amount | 1190002.78 |
| Total Medicare Standardized Payment Amount | 1164757.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 64 |
| Number Of Drug Services | 45661 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 3010470.03 |
| Total Drug Medicare AllowedAmount | 1289896.87 |
| Total Drug Medicare PaymentAmount | 1010616.53 |
| Total Drug Medicare Standardized Payment Amount | 1010616.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 3391 |
| Number Of Medicare Beneficiaries With Medical Services | 157 |
| Total Medical Submitted Charge Amount | 467240 |
| Total Medical Medicare Allowed Amount | 230956.19 |
| Total Medical Medicare Payment Amount | 179386.25 |
| Total Medical Medicare Standardized Payment Amount | 154141.08 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 98 |
| Number Of Male Beneficiaries | 59 |
| Number Of Non Hispanic White Beneficiaries | 15 |
| Number Of Black or African American Beneficiaries | 63 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 68 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 28 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 129 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 43 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.4565 |