| National Provider Identifier [NPI]: | 1790733822 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 49 LAKE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREENWICH |
| Zip Code Of The Provider | 068304501 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 183 |
| Number Of Services | 4951 |
| Number Of Medicare Beneficiaries | 2941 |
| Total Submitted Charge Amount | 247118.64 |
| Total Medicare Allowed Amount | 225637.7 |
| Total Medicare Payment Amount | 175776.54 |
| Total Medicare Standardized Payment Amount | 166669.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 30 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 33.71 |
| Total Drug Medicare AllowedAmount | 32.44 |
| Total Drug Medicare PaymentAmount | 25.38 |
| Total Drug Medicare Standardized Payment Amount | 25.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 182 |
| Number Of Medical Services | 4921 |
| Number Of Medicare Beneficiaries With Medical Services | 2941 |
| Total Medical Submitted Charge Amount | 247084.93 |
| Total Medical Medicare Allowed Amount | 225605.26 |
| Total Medical Medicare Payment Amount | 175751.16 |
| Total Medical Medicare Standardized Payment Amount | 166643.99 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 143 |
| Number Of Beneficiaries Age 65 to 74 | 979 |
| Number Of Beneficiaries Age 75 to 84 | 1028 |
| Number Of Beneficiaries Age Greater 84 | 791 |
| Number Of Female Beneficiaries | 1785 |
| Number Of Male Beneficiaries | 1156 |
| Number Of Non Hispanic White Beneficiaries | 2608 |
| Number Of Black or African American Beneficiaries | 80 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 131 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 75 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2497 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 444 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4378 |