| National Provider Identifier [NPI]: | 1215115969 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | GRANT |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2720 SUNSET BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST COLUMBIA |
| Zip Code Of The Provider | 29169 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 2116 |
| Number Of Medicare Beneficiaries | 783 |
| Total Submitted Charge Amount | 428528 |
| Total Medicare Allowed Amount | 197289.27 |
| Total Medicare Payment Amount | 152733.94 |
| Total Medicare Standardized Payment Amount | 159971.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 2116 |
| Number Of Medicare Beneficiaries With Medical Services | 783 |
| Total Medical Submitted Charge Amount | 428528 |
| Total Medical Medicare Allowed Amount | 197289.27 |
| Total Medical Medicare Payment Amount | 152733.94 |
| Total Medical Medicare Standardized Payment Amount | 159971.55 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 133 |
| Number Of Beneficiaries Age 65 to 74 | 204 |
| Number Of Beneficiaries Age 75 to 84 | 249 |
| Number Of Beneficiaries Age Greater 84 | 197 |
| Number Of Female Beneficiaries | 456 |
| Number Of Male Beneficiaries | 327 |
| Number Of Non Hispanic White Beneficiaries | 661 |
| Number Of Black or African American Beneficiaries | 105 |
| 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 | 579 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 204 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 38 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 59 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 1.972 |