| National Provider Identifier [NPI]: | 1043296874 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8401 DATAPOINT DR STE 600 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782295907 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 134 |
| Number Of Services | 10271 |
| Number Of Medicare Beneficiaries | 2143 |
| Total Submitted Charge Amount | 1361141 |
| Total Medicare Allowed Amount | 314642.21 |
| Total Medicare Payment Amount | 254574.43 |
| Total Medicare Standardized Payment Amount | 278926.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 6430 |
| Number Of Medicare Beneficiaries With Drug Services | 119 |
| Total Drug Submitted ChargeAmount | 6636 |
| Total Drug Medicare AllowedAmount | 2987.13 |
| Total Drug Medicare PaymentAmount | 2303 |
| Total Drug Medicare Standardized Payment Amount | 2303 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 131 |
| Number Of Medical Services | 3841 |
| Number Of Medicare Beneficiaries With Medical Services | 2143 |
| Total Medical Submitted Charge Amount | 1354505 |
| Total Medical Medicare Allowed Amount | 311655.08 |
| Total Medical Medicare Payment Amount | 252271.43 |
| Total Medical Medicare Standardized Payment Amount | 276623.87 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 397 |
| Number Of Beneficiaries Age 65 to 74 | 1003 |
| Number Of Beneficiaries Age 75 to 84 | 564 |
| Number Of Beneficiaries Age Greater 84 | 179 |
| Number Of Female Beneficiaries | 1534 |
| Number Of Male Beneficiaries | 609 |
| Number Of Non Hispanic White Beneficiaries | 1061 |
| Number Of Black or African American Beneficiaries | 113 |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 926 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1668 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 475 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2581 |