| National Provider Identifier [NPI]: | 1417953647 |
| Last Name Of The Provider | SULLIVAN |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 925 CHESTNUT ST |
| Street Address 2 Of The Provider | FIFTH FLOOR |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191074216 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 1756 |
| Number Of Medicare Beneficiaries | 590 |
| Total Submitted Charge Amount | 229093.43 |
| Total Medicare Allowed Amount | 120762.41 |
| Total Medicare Payment Amount | 89545.28 |
| Total Medicare Standardized Payment Amount | 83788.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 104 |
| Total Drug Medicare AllowedAmount | 74.11 |
| Total Drug Medicare PaymentAmount | 58.12 |
| Total Drug Medicare Standardized Payment Amount | 58.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 1743 |
| Number Of Medicare Beneficiaries With Medical Services | 590 |
| Total Medical Submitted Charge Amount | 228989.43 |
| Total Medical Medicare Allowed Amount | 120688.3 |
| Total Medical Medicare Payment Amount | 89487.16 |
| Total Medical Medicare Standardized Payment Amount | 83730.71 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 247 |
| Number Of Beneficiaries Age 75 to 84 | 155 |
| Number Of Beneficiaries Age Greater 84 | 114 |
| Number Of Female Beneficiaries | 379 |
| Number Of Male Beneficiaries | 211 |
| Number Of Non Hispanic White Beneficiaries | 488 |
| Number Of Black or African American Beneficiaries | 81 |
| 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 | 489 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 101 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5286 |