| National Provider Identifier [NPI]: | 1437168416 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5660 W 95TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | OAK LAWN |
| Zip Code Of The Provider | 604532380 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 1640 |
| Number Of Medicare Beneficiaries | 326 |
| Total Submitted Charge Amount | 181926.98 |
| Total Medicare Allowed Amount | 118022.98 |
| Total Medicare Payment Amount | 80622.94 |
| Total Medicare Standardized Payment Amount | 75774.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 227 |
| Number Of Medicare Beneficiaries With Drug Services | 184 |
| Total Drug Submitted ChargeAmount | 8210 |
| Total Drug Medicare AllowedAmount | 4571.42 |
| Total Drug Medicare PaymentAmount | 4418.49 |
| Total Drug Medicare Standardized Payment Amount | 4418.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 1413 |
| Number Of Medicare Beneficiaries With Medical Services | 326 |
| Total Medical Submitted Charge Amount | 173716.98 |
| Total Medical Medicare Allowed Amount | 113451.56 |
| Total Medical Medicare Payment Amount | 76204.45 |
| Total Medical Medicare Standardized Payment Amount | 71355.59 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 134 |
| Number Of Beneficiaries Age 75 to 84 | 112 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 283 |
| Number Of Male Beneficiaries | 43 |
| Number Of Non Hispanic White Beneficiaries | 304 |
| 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 | 312 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9546 |