| National Provider Identifier [NPI]: | 1154511517 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 104 ASHLAND |
| Street Address 2 Of The Provider | |
| City Of The Provider | MT ZION |
| Zip Code Of The Provider | 62549 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 2440 |
| Number Of Medicare Beneficiaries | 385 |
| Total Submitted Charge Amount | 1456925 |
| Total Medicare Allowed Amount | 222872.64 |
| Total Medicare Payment Amount | 170030.14 |
| Total Medicare Standardized Payment Amount | 174307.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 496 |
| Number Of Medicare Beneficiaries With Drug Services | 58 |
| Total Drug Submitted ChargeAmount | 24473 |
| Total Drug Medicare AllowedAmount | 9287.89 |
| Total Drug Medicare PaymentAmount | 7244.55 |
| Total Drug Medicare Standardized Payment Amount | 7244.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 92 |
| Number Of Medical Services | 1944 |
| Number Of Medicare Beneficiaries With Medical Services | 385 |
| Total Medical Submitted Charge Amount | 1432452 |
| Total Medical Medicare Allowed Amount | 213584.75 |
| Total Medical Medicare Payment Amount | 162785.59 |
| Total Medical Medicare Standardized Payment Amount | 167063.24 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 135 |
| Number Of Beneficiaries Age 75 to 84 | 116 |
| Number Of Beneficiaries Age Greater 84 | 67 |
| Number Of Female Beneficiaries | 244 |
| Number Of Male Beneficiaries | 141 |
| Number Of Non Hispanic White Beneficiaries | 362 |
| 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 | 288 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 97 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5067 |