| National Provider Identifier [NPI]: | 1306005202 |
| Last Name Of The Provider | ELLISON |
| First Name Of The Provider | TAMBREA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2550 WINDY HILL RD SE |
| Street Address 2 Of The Provider | STE 215 |
| City Of The Provider | MARIETTA |
| Zip Code Of The Provider | 300678665 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 15994 |
| Number Of Medicare Beneficiaries | 638 |
| Total Submitted Charge Amount | 2048964.48 |
| Total Medicare Allowed Amount | 499522.7 |
| Total Medicare Payment Amount | 455081.24 |
| Total Medicare Standardized Payment Amount | 374397.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 232 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 2876 |
| Total Drug Medicare AllowedAmount | 126.57 |
| Total Drug Medicare PaymentAmount | 92.74 |
| Total Drug Medicare Standardized Payment Amount | 92.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 15762 |
| Number Of Medicare Beneficiaries With Medical Services | 638 |
| Total Medical Submitted Charge Amount | 2046088.48 |
| Total Medical Medicare Allowed Amount | 499396.13 |
| Total Medical Medicare Payment Amount | 454988.5 |
| Total Medical Medicare Standardized Payment Amount | 374304.6 |
| Average Age Of Beneficiaries | 57 |
| Number Of Beneficiaries Age Less65 | 462 |
| Number Of Beneficiaries Age 65 to 74 | 144 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 410 |
| Number Of Male Beneficiaries | 228 |
| Number Of Non Hispanic White Beneficiaries | 489 |
| Number Of Black or African American Beneficiaries | 131 |
| 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 | 238 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 400 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.3693 |