| National Provider Identifier [NPI]: | 1851404768 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | MIRIAM |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 E CARPENTER ST |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627025324 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 127 |
| Number Of Services | 2520 |
| Number Of Medicare Beneficiaries | 1372 |
| Total Submitted Charge Amount | 358914 |
| Total Medicare Allowed Amount | 70011.16 |
| Total Medicare Payment Amount | 53672.37 |
| Total Medicare Standardized Payment Amount | 54426.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 127 |
| Number Of Medical Services | 2520 |
| Number Of Medicare Beneficiaries With Medical Services | 1372 |
| Total Medical Submitted Charge Amount | 358914 |
| Total Medical Medicare Allowed Amount | 70011.16 |
| Total Medical Medicare Payment Amount | 53672.37 |
| Total Medical Medicare Standardized Payment Amount | 54426.79 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 211 |
| Number Of Beneficiaries Age 65 to 74 | 623 |
| Number Of Beneficiaries Age 75 to 84 | 355 |
| Number Of Beneficiaries Age Greater 84 | 183 |
| Number Of Female Beneficiaries | 1067 |
| Number Of Male Beneficiaries | 305 |
| Number Of Non Hispanic White Beneficiaries | 1278 |
| Number Of Black or African American Beneficiaries | 73 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1042 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 330 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2999 |