| National Provider Identifier [NPI]: | 1639423734 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | JILLIAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | APRN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 263 FARMINGTON AVE |
| Street Address 2 Of The Provider | INTERNAL MEDICINE |
| City Of The Provider | FARMINGTON |
| Zip Code Of The Provider | 060302212 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 700 |
| Number Of Medicare Beneficiaries | 253 |
| Total Submitted Charge Amount | 90215 |
| Total Medicare Allowed Amount | 40695.23 |
| Total Medicare Payment Amount | 30527.26 |
| Total Medicare Standardized Payment Amount | 33521.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 59 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 2580 |
| Total Drug Medicare AllowedAmount | 998.58 |
| Total Drug Medicare PaymentAmount | 969.44 |
| Total Drug Medicare Standardized Payment Amount | 969.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 641 |
| Number Of Medicare Beneficiaries With Medical Services | 253 |
| Total Medical Submitted Charge Amount | 87635 |
| Total Medical Medicare Allowed Amount | 39696.65 |
| Total Medical Medicare Payment Amount | 29557.82 |
| Total Medical Medicare Standardized Payment Amount | 32552.17 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 69 |
| Number Of Beneficiaries Age 75 to 84 | 86 |
| Number Of Beneficiaries Age Greater 84 | 64 |
| Number Of Female Beneficiaries | 125 |
| Number Of Male Beneficiaries | 128 |
| Number Of Non Hispanic White Beneficiaries | 241 |
| 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 | 198 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0154 |