| National Provider Identifier [NPI]: | 1942407150 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | JESSICA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14546 OLD SAINT AUGUSTINE RD |
| Street Address 2 Of The Provider | BLDG A SUITE 317 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322585468 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 157 |
| Number Of Services | 102387 |
| Number Of Medicare Beneficiaries | 586 |
| Total Submitted Charge Amount | 2353612 |
| Total Medicare Allowed Amount | 840834.09 |
| Total Medicare Payment Amount | 662654.7 |
| Total Medicare Standardized Payment Amount | 652982.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 69 |
| Number Of Drug Services | 97306 |
| Number Of Medicare Beneficiaries With Drug Services | 177 |
| Total Drug Submitted ChargeAmount | 1841185 |
| Total Drug Medicare AllowedAmount | 630168.14 |
| Total Drug Medicare PaymentAmount | 493802.94 |
| Total Drug Medicare Standardized Payment Amount | 493802.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 88 |
| Number Of Medical Services | 5081 |
| Number Of Medicare Beneficiaries With Medical Services | 586 |
| Total Medical Submitted Charge Amount | 512427 |
| Total Medical Medicare Allowed Amount | 210665.95 |
| Total Medical Medicare Payment Amount | 168851.76 |
| Total Medical Medicare Standardized Payment Amount | 159179.65 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 228 |
| Number Of Beneficiaries Age 75 to 84 | 220 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 330 |
| Number Of Male Beneficiaries | 256 |
| Number Of Non Hispanic White Beneficiaries | 531 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 525 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 44 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.0909 |