| National Provider Identifier [NPI]: | 1033275896 |
| Last Name Of The Provider | ELLIS |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2115 S FREMONT AVE |
| Street Address 2 Of The Provider | SUITE 2300 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 658042239 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 2013 |
| Number Of Medicare Beneficiaries | 409 |
| Total Submitted Charge Amount | 210810 |
| Total Medicare Allowed Amount | 138227.49 |
| Total Medicare Payment Amount | 106066.9 |
| Total Medicare Standardized Payment Amount | 115849.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 448 |
| Number Of Medicare Beneficiaries With Drug Services | 179 |
| Total Drug Submitted ChargeAmount | 11633 |
| Total Drug Medicare AllowedAmount | 7015.81 |
| Total Drug Medicare PaymentAmount | 6487.78 |
| Total Drug Medicare Standardized Payment Amount | 6487.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 1565 |
| Number Of Medicare Beneficiaries With Medical Services | 409 |
| Total Medical Submitted Charge Amount | 199177 |
| Total Medical Medicare Allowed Amount | 131211.68 |
| Total Medical Medicare Payment Amount | 99579.12 |
| Total Medical Medicare Standardized Payment Amount | 109361.86 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 170 |
| Number Of Beneficiaries Age 75 to 84 | 134 |
| Number Of Beneficiaries Age Greater 84 | 58 |
| Number Of Female Beneficiaries | 212 |
| Number Of Male Beneficiaries | 197 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 365 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 44 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9795 |