| National Provider Identifier [NPI]: | 1932425089 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | LINDA |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1350 E WALNUT ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SEGUIN |
| Zip Code Of The Provider | 781555126 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 1875 |
| Number Of Medicare Beneficiaries | 339 |
| Total Submitted Charge Amount | 348593 |
| Total Medicare Allowed Amount | 146602.33 |
| Total Medicare Payment Amount | 105465.41 |
| Total Medicare Standardized Payment Amount | 111211.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 175 |
| Number Of Medicare Beneficiaries With Drug Services | 83 |
| Total Drug Submitted ChargeAmount | 5207 |
| Total Drug Medicare AllowedAmount | 2788.89 |
| Total Drug Medicare PaymentAmount | 2668.93 |
| Total Drug Medicare Standardized Payment Amount | 2668.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 1700 |
| Number Of Medicare Beneficiaries With Medical Services | 338 |
| Total Medical Submitted Charge Amount | 343386 |
| Total Medical Medicare Allowed Amount | 143813.44 |
| Total Medical Medicare Payment Amount | 102796.48 |
| Total Medical Medicare Standardized Payment Amount | 108542.98 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 159 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 242 |
| Number Of Male Beneficiaries | 97 |
| Number Of Non Hispanic White Beneficiaries | 271 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 277 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2825 |