| National Provider Identifier [NPI]: | 1013948348 |
| Last Name Of The Provider | SHULL |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1708 HIGH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH BEND |
| Zip Code Of The Provider | 466132633 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 62 |
| Number Of Services | 640 |
| Number Of Medicare Beneficiaries | 154 |
| Total Submitted Charge Amount | 98825 |
| Total Medicare Allowed Amount | 41932.88 |
| Total Medicare Payment Amount | 31431.21 |
| Total Medicare Standardized Payment Amount | 33314.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 160 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 4193 |
| Total Drug Medicare AllowedAmount | 2373.23 |
| Total Drug Medicare PaymentAmount | 2284.28 |
| Total Drug Medicare Standardized Payment Amount | 2284.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 480 |
| Number Of Medicare Beneficiaries With Medical Services | 154 |
| Total Medical Submitted Charge Amount | 94632 |
| Total Medical Medicare Allowed Amount | 39559.65 |
| Total Medical Medicare Payment Amount | 29146.93 |
| Total Medical Medicare Standardized Payment Amount | 31030.1 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 101 |
| Number Of Beneficiaries Age 65 to 74 | 32 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 90 |
| Number Of Male Beneficiaries | 64 |
| Number Of Non Hispanic White Beneficiaries | 92 |
| Number Of Black or African American Beneficiaries | 42 |
| 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 | 47 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 107 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5657 |