| National Provider Identifier [NPI]: | 1356490775 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1107 E 66TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAVANNAH |
| Zip Code Of The Provider | 314045701 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 1366 |
| Number Of Medicare Beneficiaries | 269 |
| Total Submitted Charge Amount | 81182 |
| Total Medicare Allowed Amount | 36489.5 |
| Total Medicare Payment Amount | 26600.25 |
| Total Medicare Standardized Payment Amount | 28215.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 358 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 3179 |
| Total Drug Medicare AllowedAmount | 1852.48 |
| Total Drug Medicare PaymentAmount | 1795.95 |
| Total Drug Medicare Standardized Payment Amount | 1795.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 1008 |
| Number Of Medicare Beneficiaries With Medical Services | 268 |
| Total Medical Submitted Charge Amount | 78003 |
| Total Medical Medicare Allowed Amount | 34637.02 |
| Total Medical Medicare Payment Amount | 24804.3 |
| Total Medical Medicare Standardized Payment Amount | 26419.86 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 133 |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 153 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 90 |
| Number Of Black or African American Beneficiaries | 168 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 94 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 175 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3572 |