| National Provider Identifier [NPI]: | 1669567434 |
| Last Name Of The Provider | ELLISON |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2127 E BASELINE RD STE 104 |
| Street Address 2 Of The Provider | |
| City Of The Provider | TEMPE |
| Zip Code Of The Provider | 852831537 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 641 |
| Number Of Medicare Beneficiaries | 133 |
| Total Submitted Charge Amount | 109467.4 |
| Total Medicare Allowed Amount | 49854.32 |
| Total Medicare Payment Amount | 34282.04 |
| Total Medicare Standardized Payment Amount | 36022.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 97.48 |
| Total Drug Medicare AllowedAmount | 42.73 |
| Total Drug Medicare PaymentAmount | 35.45 |
| Total Drug Medicare Standardized Payment Amount | 35.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 618 |
| Number Of Medicare Beneficiaries With Medical Services | 133 |
| Total Medical Submitted Charge Amount | 109369.92 |
| Total Medical Medicare Allowed Amount | 49811.59 |
| Total Medical Medicare Payment Amount | 34246.59 |
| Total Medical Medicare Standardized Payment Amount | 35987.36 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 76 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | 118 |
| 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 | 120 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8838 |