| National Provider Identifier [NPI]: | 1811205750 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 44305 HARMONY LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | BELLEVILLE |
| Zip Code Of The Provider | 481112449 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 4927 |
| Number Of Medicare Beneficiaries | 862 |
| Total Submitted Charge Amount | 766555 |
| Total Medicare Allowed Amount | 270132.19 |
| Total Medicare Payment Amount | 204996.51 |
| Total Medicare Standardized Payment Amount | 235173.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1289 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 30180 |
| Total Drug Medicare AllowedAmount | 928.02 |
| Total Drug Medicare PaymentAmount | 693.94 |
| Total Drug Medicare Standardized Payment Amount | 693.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 3638 |
| Number Of Medicare Beneficiaries With Medical Services | 862 |
| Total Medical Submitted Charge Amount | 736375 |
| Total Medical Medicare Allowed Amount | 269204.17 |
| Total Medical Medicare Payment Amount | 204302.57 |
| Total Medical Medicare Standardized Payment Amount | 234479.61 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 186 |
| Number Of Beneficiaries Age 65 to 74 | 229 |
| Number Of Beneficiaries Age 75 to 84 | 218 |
| Number Of Beneficiaries Age Greater 84 | 229 |
| Number Of Female Beneficiaries | 543 |
| Number Of Male Beneficiaries | 319 |
| Number Of Non Hispanic White Beneficiaries | 596 |
| Number Of Black or African American Beneficiaries | 222 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 297 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 565 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 69 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 31 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.5081 |