| National Provider Identifier [NPI]: | 1447276225 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 250 PONCE DE LEON AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | DECATUR |
| Zip Code Of The Provider | 300303406 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 79759 |
| Number Of Medicare Beneficiaries | 626 |
| Total Submitted Charge Amount | 7432392 |
| Total Medicare Allowed Amount | 2432553.48 |
| Total Medicare Payment Amount | 1895503.51 |
| Total Medicare Standardized Payment Amount | 1887815.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 76240 |
| Number Of Medicare Beneficiaries With Drug Services | 517 |
| Total Drug Submitted ChargeAmount | 100297 |
| Total Drug Medicare AllowedAmount | 29251.76 |
| Total Drug Medicare PaymentAmount | 22745.44 |
| Total Drug Medicare Standardized Payment Amount | 22745.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 3519 |
| Number Of Medicare Beneficiaries With Medical Services | 626 |
| Total Medical Submitted Charge Amount | 7332095 |
| Total Medical Medicare Allowed Amount | 2403301.72 |
| Total Medical Medicare Payment Amount | 1872758.07 |
| Total Medical Medicare Standardized Payment Amount | 1865070.14 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 406 |
| Number Of Beneficiaries Age 65 to 74 | 142 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 266 |
| Number Of Male Beneficiaries | 360 |
| Number Of Non Hispanic White Beneficiaries | 68 |
| Number Of Black or African American Beneficiaries | 510 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 243 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 383 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 2 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 21 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 7.6244 |