| National Provider Identifier [NPI]: | 1740248764 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7601 PIONEERS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LINCOLN |
| Zip Code Of The Provider | 685064675 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 12656 |
| Number Of Medicare Beneficiaries | 3850 |
| Total Submitted Charge Amount | 1080451.18 |
| Total Medicare Allowed Amount | 247512.77 |
| Total Medicare Payment Amount | 195940.13 |
| Total Medicare Standardized Payment Amount | 214478.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 6787 |
| Number Of Medicare Beneficiaries With Drug Services | 102 |
| Total Drug Submitted ChargeAmount | 5399.18 |
| Total Drug Medicare AllowedAmount | 2380.74 |
| Total Drug Medicare PaymentAmount | 1834.43 |
| Total Drug Medicare Standardized Payment Amount | 1834.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 173 |
| Number Of Medical Services | 5869 |
| Number Of Medicare Beneficiaries With Medical Services | 3850 |
| Total Medical Submitted Charge Amount | 1075052 |
| Total Medical Medicare Allowed Amount | 245132.03 |
| Total Medical Medicare Payment Amount | 194105.7 |
| Total Medical Medicare Standardized Payment Amount | 212644.44 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 433 |
| Number Of Beneficiaries Age 65 to 74 | 1559 |
| Number Of Beneficiaries Age 75 to 84 | 1201 |
| Number Of Beneficiaries Age Greater 84 | 657 |
| Number Of Female Beneficiaries | 2621 |
| Number Of Male Beneficiaries | 1229 |
| Number Of Non Hispanic White Beneficiaries | 3720 |
| Number Of Black or African American Beneficiaries | 34 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3205 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 645 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.241 |