| National Provider Identifier [NPI]: | 1437350030 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | MARC |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16838 E PALISADES BLVD |
| Street Address 2 Of The Provider | SUITE C153 |
| City Of The Provider | FOUNTAIN HILLS |
| Zip Code Of The Provider | 852683845 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 3379 |
| Number Of Medicare Beneficiaries | 473 |
| Total Submitted Charge Amount | 178201.08 |
| Total Medicare Allowed Amount | 155684.86 |
| Total Medicare Payment Amount | 113280.65 |
| Total Medicare Standardized Payment Amount | 120499.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 127 |
| Number Of Medicare Beneficiaries With Drug Services | 83 |
| Total Drug Submitted ChargeAmount | 3252.82 |
| Total Drug Medicare AllowedAmount | 3144.32 |
| Total Drug Medicare PaymentAmount | 3073.93 |
| Total Drug Medicare Standardized Payment Amount | 3073.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 3252 |
| Number Of Medicare Beneficiaries With Medical Services | 473 |
| Total Medical Submitted Charge Amount | 174948.26 |
| Total Medical Medicare Allowed Amount | 152540.54 |
| Total Medical Medicare Payment Amount | 110206.72 |
| Total Medical Medicare Standardized Payment Amount | 117425.19 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 244 |
| Number Of Beneficiaries Age 75 to 84 | 157 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 229 |
| Number Of Male Beneficiaries | 244 |
| Number Of Non Hispanic White Beneficiaries | 460 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8856 |