| National Provider Identifier [NPI]: | 1073595377 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3366 NW EXPRESSWAY |
| Street Address 2 Of The Provider | SUITE 720 |
| City Of The Provider | OKLAHOMA CITY |
| Zip Code Of The Provider | 731124462 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 14790 |
| Number Of Medicare Beneficiaries | 1601 |
| Total Submitted Charge Amount | 547476.83 |
| Total Medicare Allowed Amount | 517770 |
| Total Medicare Payment Amount | 362168.7 |
| Total Medicare Standardized Payment Amount | 388311.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 96 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 434.16 |
| Total Drug Medicare AllowedAmount | 167.38 |
| Total Drug Medicare PaymentAmount | 112.51 |
| Total Drug Medicare Standardized Payment Amount | 112.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 14694 |
| Number Of Medicare Beneficiaries With Medical Services | 1601 |
| Total Medical Submitted Charge Amount | 547042.67 |
| Total Medical Medicare Allowed Amount | 517602.62 |
| Total Medical Medicare Payment Amount | 362056.19 |
| Total Medical Medicare Standardized Payment Amount | 388198.98 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 653 |
| Number Of Beneficiaries Age 75 to 84 | 636 |
| Number Of Beneficiaries Age Greater 84 | 281 |
| Number Of Female Beneficiaries | 686 |
| Number Of Male Beneficiaries | 915 |
| Number Of Non Hispanic White Beneficiaries | 1543 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 21 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1585 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 16 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9658 |