| National Provider Identifier [NPI]: | 1932153632 |
| Last Name Of The Provider | SULLIVAN-OGG |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | ARNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 401 HIGHWAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | UNDERWOOD |
| Zip Code Of The Provider | 51576 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 113 |
| Number Of Medicare Beneficiaries | 24 |
| Total Submitted Charge Amount | 9738 |
| Total Medicare Allowed Amount | 4359.02 |
| Total Medicare Payment Amount | 3786.75 |
| Total Medicare Standardized Payment Amount | 4471.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1300 |
| Total Drug Medicare AllowedAmount | 958.75 |
| Total Drug Medicare PaymentAmount | 934.16 |
| Total Drug Medicare Standardized Payment Amount | 934.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 87 |
| Number Of Medicare Beneficiaries With Medical Services | 24 |
| Total Medical Submitted Charge Amount | 8438 |
| Total Medical Medicare Allowed Amount | 3400.27 |
| Total Medical Medicare Payment Amount | 2852.59 |
| Total Medical Medicare Standardized Payment Amount | 3537.24 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 13 |
| Number Of Male Beneficiaries | 11 |
| Number Of Non Hispanic White Beneficiaries | 24 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 24 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 0 |
| 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 | 54 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.481 |