| National Provider Identifier [NPI]: | 1093875973 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | WENDELL |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 682 HEMLOCK STREET |
| Street Address 2 Of The Provider | SUITE 490 |
| City Of The Provider | MACON |
| Zip Code Of The Provider | 31201 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 6504 |
| Number Of Medicare Beneficiaries | 1704 |
| Total Submitted Charge Amount | 2171922 |
| Total Medicare Allowed Amount | 569770.9 |
| Total Medicare Payment Amount | 431874.52 |
| Total Medicare Standardized Payment Amount | 457792.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 599 |
| Number Of Medicare Beneficiaries With Drug Services | 120 |
| Total Drug Submitted ChargeAmount | 81580 |
| Total Drug Medicare AllowedAmount | 25735.79 |
| Total Drug Medicare PaymentAmount | 19802.6 |
| Total Drug Medicare Standardized Payment Amount | 19802.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 76 |
| Number Of Medical Services | 5905 |
| Number Of Medicare Beneficiaries With Medical Services | 1704 |
| Total Medical Submitted Charge Amount | 2090342 |
| Total Medical Medicare Allowed Amount | 544035.11 |
| Total Medical Medicare Payment Amount | 412071.92 |
| Total Medical Medicare Standardized Payment Amount | 437989.84 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 279 |
| Number Of Beneficiaries Age 65 to 74 | 664 |
| Number Of Beneficiaries Age 75 to 84 | 579 |
| Number Of Beneficiaries Age Greater 84 | 182 |
| Number Of Female Beneficiaries | 886 |
| Number Of Male Beneficiaries | 818 |
| Number Of Non Hispanic White Beneficiaries | 1286 |
| Number Of Black or African American Beneficiaries | 399 |
| 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 | 1349 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 355 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 71 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.8328 |