| National Provider Identifier [NPI]: | 1285675405 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2001 PARKVIEW DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | EL RENO |
| Zip Code Of The Provider | 730362107 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 5235 |
| Number Of Medicare Beneficiaries | 498 |
| Total Submitted Charge Amount | 245203 |
| Total Medicare Allowed Amount | 175690 |
| Total Medicare Payment Amount | 118022.43 |
| Total Medicare Standardized Payment Amount | 125544.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 1059 |
| Number Of Medicare Beneficiaries With Drug Services | 219 |
| Total Drug Submitted ChargeAmount | 11951 |
| Total Drug Medicare AllowedAmount | 4931.46 |
| Total Drug Medicare PaymentAmount | 3534.47 |
| Total Drug Medicare Standardized Payment Amount | 3534.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 4176 |
| Number Of Medicare Beneficiaries With Medical Services | 497 |
| Total Medical Submitted Charge Amount | 233252 |
| Total Medical Medicare Allowed Amount | 170758.54 |
| Total Medical Medicare Payment Amount | 114487.96 |
| Total Medical Medicare Standardized Payment Amount | 122010.5 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 166 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 90 |
| Number Of Female Beneficiaries | 253 |
| Number Of Male Beneficiaries | 245 |
| Number Of Non Hispanic White Beneficiaries | 432 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 27 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 397 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 101 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0726 |