| National Provider Identifier [NPI]: | 1245259134 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | KAREN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | CNM, FNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 MOUNT HOPE AVE |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | BANGOR |
| Zip Code Of The Provider | 044015691 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Certified Nurse Midwife |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 308 |
| Number Of Medicare Beneficiaries | 75 |
| Total Submitted Charge Amount | 33754.32 |
| Total Medicare Allowed Amount | 20838.19 |
| Total Medicare Payment Amount | 14970.34 |
| Total Medicare Standardized Payment Amount | 15914.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 15 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 507 |
| Total Drug Medicare AllowedAmount | 336.57 |
| Total Drug Medicare PaymentAmount | 329.59 |
| Total Drug Medicare Standardized Payment Amount | 329.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 293 |
| Number Of Medicare Beneficiaries With Medical Services | 75 |
| Total Medical Submitted Charge Amount | 33247.32 |
| Total Medical Medicare Allowed Amount | 20501.62 |
| Total Medical Medicare Payment Amount | 14640.75 |
| Total Medical Medicare Standardized Payment Amount | 15585.36 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | 14 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 58 |
| Number Of Male Beneficiaries | 17 |
| 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 | 43 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.932 |