| National Provider Identifier [NPI]: | 1134349137 |
| Last Name Of The Provider | BRILL |
| First Name Of The Provider | SEULI |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2050 KENNY ROAD |
| Street Address 2 Of The Provider | SUITE 2400 |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 43221 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 243 |
| Number Of Medicare Beneficiaries | 30 |
| Total Submitted Charge Amount | 31142.9 |
| Total Medicare Allowed Amount | 13571.09 |
| Total Medicare Payment Amount | 10390.69 |
| Total Medicare Standardized Payment Amount | 10844.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 50 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 2342.9 |
| Total Drug Medicare AllowedAmount | 912.07 |
| Total Drug Medicare PaymentAmount | 862.91 |
| Total Drug Medicare Standardized Payment Amount | 862.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 193 |
| Number Of Medicare Beneficiaries With Medical Services | 30 |
| Total Medical Submitted Charge Amount | 28800 |
| Total Medical Medicare Allowed Amount | 12659.02 |
| Total Medical Medicare Payment Amount | 9527.78 |
| Total Medical Medicare Standardized Payment Amount | 9981.28 |
| Average Age Of Beneficiaries | 61 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 18 |
| Number Of Male Beneficiaries | 12 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 16 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 40 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.105 |